CC Resolution No. 21-089 establishing a Suicide Prevention Policy_revised 8/22/23RESO[UTION N0. 21-089
A RESOLUTION OF THE CUPERTINO CITY COUNCIL
EST ABLISHING A SUICIDE PREVENTION POLICY
WHEREAS, the City of Cupertino recognizes suicide as a public health
issue, evidenced by Santa Clara County Behavioral Health Services data which
shows that after a three-year decline in the suicide rate in the County, suicide rates
increased in 2018 and 2019; and
WHEREAS, the Suicide Prevention Policy seeks to support the strategies
recommended by the Santa Clara County Suicide Prevention Strategic Plan; and
WHEREAS, educating the community on suicide risk factors, warning
signs, how to report threats of suicide or those showing signs of becoming at risk,
and removing the stigma about mental health treatment, recovery, and resiliency,
is good public policy; and
WHEREAS, the Suicide Prevention Policy formalizes a process by which
general resources are shared and safe messaging best practices are followed when
communicating with employees and the comrmuiity; and
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of
Cupertino adopts and approves the attached Suicide Prevention Policy, as the
official suicide prevention policy of the City of Cupertino.
PASSED AND ADOPTED at a regular meeting of the City Council of the City of
Cupertino this 21"' day of September 2021, by the following vote:
Vote
AYES:
NOES:
ABSENT:
ABST AIN:
Members of the City Council
Paul, Chao, Moore, Wei, Willey
None
None
None
Resolution No. 21-089
Page 2
SIGNED:
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( T'i
Darcy Paul,q
City of Cup
Date
ATTEST:
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k. ,F'-f[- - " I ' / 1-l
Kj'rstenSqriarcia, City Clerk Date
CUPERTINO
CITY OF CUPERTINO
SUICIDE PREVENTION POLICY
Purpose
This polig reflects an ongoing commitment to increase awareness of suicide as a public health
problem. The framework in this policy promotes the planning, implementation and evaluation
of strategies for suicide prevention and intervention, as well as encouraging mental health care.
Policy
This policy shall advance current strategies and best practices of the Santa Clara County
Behavioral Health Services, National Council for Behavioral Health, National Alliance on
Mental Illness, and the World Health Organization.
This policy shall call for the collaboration between the City of Cupertino and local and
regional organizations, to provide information to employees and residents to gain a better
understanding of the causes of suicide, learn the appropriate methods for identifying those
at risk, and leam how to report threats of suicide or those showing signs of becorning at risk
to the appropriate authorities.
The City will promote strategies and resources provided by the County as well as the
Prevention Reso'irce Centerl under the following guiding framework:
City Employees
Annuany, the City Manager or designee will share with its current employees
irformation that helps staff and gain a better understanding of the causes of suicide
and learn the appropriate methods for identifying and preventing the loss of life. The
Human Resources Division will work with the County's Behavioral Health Services
Suicide Prevention Program to ensure that information shared reflects current
research. The City shall provide a copy of this policy to all employees.
City Facilities
The City Manager or designee will develop public safety protocols governing a
response to a suicide attempt on City facilities and will ensure that those protocols
are reviewed annually. This review of protocols will seek to update internal
procedures and address any needed support for employees that may witness such
events. The City Manager or designee will further ensure an appropriate
communications strategy is in place if a suicide attempt occurs in a City facility. The
I littps://www.sprc.org/
Resolution No. 21-089
Page 5
commiu"iication strategy will reflect best practices for reporting on suicide, as
provided by the County.
City Residents
The City will link to the County's Behavioral Health Services webpage2 and actively
collaborate with the County to disseminate ii'fornnation including event information
and resources as they become available. The City Council will also raise awareness
by recognizing National Suicide Prevention Month annually in September arid
support state and/or federal legislation aimed at increasing awareness and reducing
deaths by suicide.
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This document is dedicated to Santa Clara County residents
who have /ost their lives to suicide, those who have experienced the
tragic loss of a loved one by suicide, those who are survivors of suicide
attempts, and those who may contemplate suicide now or in the
future. MO)/ this document serve to inspire individuals, organizations
and communities to implement strategies needed to protect our
county's greatest resource-our residents.
This work is intended to honor and memorialize all whose loss
and struggle has inspired us to take action.
ii io
Santa Clara County Suicide Prevention Advisory Committee
Co-Chairs
Hon. Liz Kniss, Santa Clara County Supervisor, District 5
Victor Ojakian, Santa Clara County Mental Health Board Member
Santa Clara County Board of Supervisors
Hon. Ken Yeager, District 4, President
Hon. Dave Cortese, District 3, Vice President
Hon. Donald F. Gage, District 1
Hon. George Shirakawa, District 2
Hon. Liz Kniss, District 5
County Executive
Dr. Jeffrey Smith
. x ' T S
Attachment: Santa Clara County Suicide Pro-ention Strategic Plan (Suicide Prevention Policy)
i-'--
If you or someone you know or love is in crisis, there are services, resources and
help available at Santa Clara County's -
Suicide and Crisis Services (SACS) Hotline
Toll-Free
1-855-278-4204
National Suicide Prevention Lifeline
1-800-273-T ALK (8255)
For Veterans
1-800-273-TALK (8255) press 1
Additional resources also are listed on the Santa Clara County's Mental Health
Department website: www,sccgov.or@/spac under the Suicide Prevention and
Local Resources section on the Suicide Prevention Resources page.
Giving People Help and Hope
Santa Clara County Suicide Prevention Action Plan
TABLE OF CONTENTS
A Message from Supervisor Liz Kniss and Vic Ojakian,
Co-Chairs of the Santa Clara County
SuicidePreventionAdvisoryCommittee 9
Santa Clara County Suicide Prevention Advisory Committee
Members and Staff List with Special Acknowledgements,,,,,,,,,,,,,,,,,,,,,,,,,10
Introduction 13
1.
II.
Why We Care
n The Impact of Suicide in Santa Clara County
What We Did
The Committee Planning Process
s The Planning Approach
s Planning Steps
Ill. What We Learned
a Language Counts
a Local and National Suicide Data
17
17
ffl Suicide by Age 31
s Suicides by Lesbian, Gay, and Bisexual Individuals 32
s Suicide by Race and Ethnicity
s Suicide by Gender
s Suicide by City
s Suicides among Custody Populations
ai Suicides by Military Personnel -Active Duty, National Guard,
ReservistsandVeterans 36
s Other Possible Correlations: More Data Is Needed 38
s Suicide Risk and Mental Illness
s Suicide Risk and Alcohol Consumption
41
43
s Suicide Risk Factors and Warning Signs 44
Packet Pg 509
Factors that May Protect Against Suicide
IV. Review and Summary of Local Needs
45
49
s Local Needs Across the Lifespan 49
s Additional Strategies: Community Education and Information 55
Additional Strategies: Communication Practices 55
s Additional Strategies: Policy and Governance Advocacy,,,,,,,,,,,,,,,,,,,,,56
ii Additional Needs: Data Monitoring and Evaluation 57
Local Suicide Resources: A Range of Services
a Pending and Future Additional Prevention Resources
s What Experts Recommend
Best Practices - Evolving Knowledge 59
59
58
57
64
68
63
V. What We Recommend - Five Overarching
and Interconnected Prevention Strategies
ffl Strategy One - Implement and coordinate suicide prevention and
intervention programs and services for targeted high risk
populations
s Strategy Two - Implement a community education and information
campaign to increase public awareness of suicide and
suicide prevention
ffl Strategy Three - Develop local communication "best practices"
to improve media coverage and public dialogue related to suicide 72
s Strategy Four - Implement policy and governance advocacy
to promote systems change in suicide awareness and prevention 75
n Strategy Five -Establish a robust data collection and monitoring
system to increase the scope and availability of suicide-related data
and to evaluate suicide prevention efforts 79
Vl. Next Steps
Vll. Appendix
85
87
ffl Attachment 1: Suicide in Santa Clara County by Zip Code,
2000-2006 Suicide-Homicide Comparison Table
s Attachment 2: Santa Clara County Community Agencies and
Programs that Interface with Suicide Attempters, Victims,
and Loved Ones
89
93
s Attachment 3: Best Practices Recommendations 97
s Attachment 4: Summary of Public Forum Input 103
a Attachment 5: Palo Alto Unified School District Suicide Prevention
and Mental Health Promotion Policy 125
s Attachment 6: References 131
Attachment: Santa Clara County Suicide Prt;vention Strategic Plan (Suicide Prevention Policy)
A Message from County Supervisor Liz Kniss and Victor Ojakian
Co-Chairs, Suicide Prevention Advisory Committee
Suicide devastates families and takes a tremendous toll within communities. Our nation loses
approximately 30,000 lives to this tragedy each year. Every 16 to 18 minutes another person
dies by self-inflicted causes. In Santa Clara County, death by suicide occurs, on average, every
three days.
When someone dies by suicide, the tragedy isn't limited to the loss of life and human potential.
The heartbreaking pain, intense grief and overwhelming sorrow loved ones experience are
complicated by feelings of anger, shock, and second-guessing.
The issue of suicide was brought to the forefront of our communities" attention in 2009,
prompted by the suicide of four adolescents in a less than six-month period. With a renewed
focus on coordinated and effective suicide prevention services throughout Santa Clara County,
the Board of Supervisors supported development of an action based strategy through a broad-
based group of expert-professionals from a wide range of fields.
Vic Ojakian and I are pleased to have served as Co-Chairs of this dynamic group of individuals
and organizational representatives. Vic is a member of the Santa Clara County Mental Health
Board, a former Mayor of Palo Alto and, along with his wife Mary, a national advocate for
improved prevention services since they lost their son to suicide in 2004.
The Suicide Prevention Adv,isory Committee diligently reviewed data, listened to experts and
community members, and studied best practices in prevention and response in order to
formulate an action plan in Santa Clara County. We would like to extend our sincere gratitude
to the individuals who served on this committee for their significant contribution to the
development of this draft plan.
In addition, we thank members of the public who attended committee meetings and/or
participated in the April 28, 2009, Public Forum at which the data, deliberative process and
preliminary conclusions of the Suicide Prevention Advisory Committee were enriched. Our
thanks go out to each and every one of you who devoted your time, energy and expertise to
this critically important endeavor.
While the current plan is a working document that is subject to change as it continues to be
reviewed by the community-it is nevertheless an important blueprint for next steps. I urge all
Santa Clara County residents to read this plan, think about ways in which you can add to its
recommendations and/or help to implement its recommendations, and become active in this
vital effort to save lives.
Hon. Liz Kniss, Supervisor, District 5Victor Ojakian
SANTA CLARA COUNTY SUICIDE PREVENTION ADVISORY COMMITTEE
This broad and diverse group of individuals, representing a cross-section of our county,
dedicated six months to create this plan. The work of this committee was imbued with the
passion that comes, in iarge part, from personal experience with the pain of suicide. More than
60% of the individuals in this committee have either lost a loved one or friend to suicide or have
attempted to take their own lives but, fortunately for us, lived so they could share their
knowledge and achieve our goal to reduce the number of deaths by suicide.
Members:
JeffArnold,M.D. JenniferJones
Santa Clara Valley Medical Center Emergency Room Suicide Attempt Survivor / Santa Clara County
Mental Health Department's Consumer Affairs
MaryannBa"y SheilaMitchell
Santa Clara County Custody Health Services Santa Clara County Probation Department
Dennis Burns
Palo Alto Police Department
Ginny Cutler
EMQFF Child and Adolescent Mobile Crisis Program
Robert (Bob) Garner
Santa Clara County
Department of Alcohol and Drug Services
Mitch Gevelber, M.D.
Santa Clara Valley Medical Center,
Adolescent Medicine
Kelly Green, Alternate
San Mateo County Transit District
Michael Haberecht, M.D., Ph.D.
Stanford Counseling and Psychological Services
Melanie Hale, M.S., LCSW
Foothill College
Tiffany Ho, M.D.
Santa Clara County
Mental Health Department
Hope Holland
Suicide Attempt Survivor / California Network of
Mental Health Clients/ Santa Clara Chapter of
National Alliance on Mental Illness
Don Johnson, Member
Mental Health Department's Ethnic and Cultural
Community Advisory Committee
Dave Newman
Law Enforcement Liaison, South County
Bernie (Deacon) Nojadera
Interfaith Advisory Committee,
Diocese of San Jose
Cary Matsuoka
Santa Clara County Superintendents' Association
ThuHien Nguyen, Ph.D.
Santa Clara County Mental Health Department,
Mental Health Services Act
Cultural Competency Coordinator
Erin O'Brien
Association of Mental Health Contract Agencies
Joseph O'Hara, M.D.
Santa Clara County
Medical Examiner-Coroner Office
Mary Ojakian
American Foundation for Suicide Prevention
Chris Pacheco
Council on Aging Silicon Valley
Dan Peddycord, R.N., M.P.A./H.A.
Santa Clara County Public Health Department
Hon. Joe Pirzynski, Vice Mayor
Town of Los Gatos,
Santa Clara County Cities Association
Janin Rimper
Suicide and Crisis Services Volunteer
o
Amari Romero-Thomas
211 Santa Clara County, United Way Silicon Valley
Mark Simon
SamTrans, Caltrain, San Mateo County
Transportation Authority
David Sisson
Suicide Attempt Survivor/ Community Member
Wiggsy Sivertsen
San Jos6 State University
Kevin Skelly
Palo Alto Unified School District
Pamela Smith Martin
Hospital Council of Northern and Central California
Tasha Souter, M.D.
Veterans Administration Hospital, Trauma Recovery
Nicole Squires
Policy Aide to Supervisor Kniss
Eddie Subega
Santa Clara County
Suicide and Crisis Services (Hotline)
Paul Taylor, Alternate
Momentum
Kris Wang, Alternate
Santa Clara County Cities Association
Lorraine Zeller, Alternate
Survivor and Peer Mentor
Staff:
Nancy Dane Peria, Ph.D., Director, Santa Clara County Mental Health Department
Elena Tindall, M.Ed., Santa Clara County Mental Health Department Prevention and Early Intervention Consultant
and temporary Liaison to the State Office of Suicide Prevention
Ky Le, Santa Clara County Mental Health Department Mental Health Services Act Manager
lean McCorquodale, Mental Health Department Consultant
Tracy Hern McGreevy, Photographer
And, with Special Thanks to:
11nterpret- for simultaneous translation
EMQ for hosting meetings
Christine Nguyen for assistance at the public forum
CTI for Suicide Prevention Website Support
MIG, Inc. for graphic design and meeting facilitation
€JI
Attachment: Santa Clara County Suicide Prb,ention Strategic Plan (Suicide Prevention Policy)
Introduction
When someone dies by suicide, the loss of that precious human life and the loss of that
person's potential is only one of the anguishing outcomes: There can be no more
heartbreaking pain than having a loved one end his or her life. Along with intense grief from
the gaping hole in one's life, there is overwhelming sorrow about the loss that is typically mixed
with a surplus of other tormenting emotions.
In Santa Clara County, death by suicide is the lO'h leading cause of death. Our County ranks 54'h
out of California's 58 counties (with 58 being the worst) in the rate of adolescent self-inflicted
injury.l Death by suicide occurs, on average, every three days; and there are 2 suicide attempts
every day, and an estimated 14 suicidal gestures every day in Santa Clara County.
This troubling reality of suicide in Santa Clara County stands in stark contrast to our positive
identity-to our sense of pride in being the largest member of the economic region called
Silicon Valley, a world leader in development of new technologies and industries, where our
cities are frequently ranked among the highest in the nation in overall health and safety. We
pride ourselves as being civic-minded and welcoming of all who choose Santa Clara Valley as
their home; and yet, one out of every ten deaths is the result of someone taking their own life.
This plan is the effort of many who endeavor to understand the enigma of suicide in Silicon
Valley and to take a stand, together as a community, to prevent it. Our belief is one death by
suicide is one death too many. One person struggling with despair and the contemplation of
taking his/ her own life is one person too many.
Our mission is to bring community awareness to the issue of suicide and to engage a community
effort to stop it. Additionally, as we do so, we hope to enlist the public in our effort to contribute
to the success of other communities that endeavor to take action to prevent suicide.
We have organized the following report so that you, the reader, will understand how we went
about our planning work, what we learned about suicide as we planned, and how we arrived at
the five overarching recommendations of this Plan. Those recommendations, discussed in detail
in Section V. What We Recommend, focus on community-wide education, policy development,
data collection and evaluation, communication and media practices, and an array of suicide
prevention programs and services. Some of the services recommended for all ages include:
s Screening and referral resources in primary care and other caregiving settings
g Training for professionals, service providers and community members on identification
and response to individuals at risk
s Crisis Hotline and a single, countywide access point/telephone number
ii Accessible, affordable and appropriate crisis, counseling and support services
a Mobile crisis unit
s Self-help centers in communities
[I
a Phone consultation services
a Post-incident care for individuals and families after a 5150 episode (involuntary
admission to residential psychiatric care for up to 72 hours)
a Public recognition of individuals who connect people at risk of suicide to resources
ffi Incorporating individuals who have survived their own attempts to die by suicide and
individuals who have lost a loved one to suicide in the efforts to increase awareness and
prevention
The Suicide Prevention Advisory Committee is proposing broad recommendations to:
One: Implement and coordinate suicide intervention programs and services for targeted
high risk populations
Two: Implement a community education and information campaign to increase public
awareness of suicide and suicide prevention
Three: Develop local communication"best practices" to improve media coverage and
public dialogue related to suicide
Four: Implement a policy and governance advocacy initiative to promote systems
change in suicide awareness and prevention
Five: Establish a robust data collection and monitoring system to increase the scope and
availability of suicide-related data and evaluate suicide prevention efforts
Each of these broad recommendations, once endorsed by the Mental Health Board and local
stakeholders and approved by the Board of Supervisors, will be developed into implementation
plans, including well defined deliverables with budgets and specific procurement
recommendations. It is expected that a significant portion of the funding for the plan
components will be funded through Mental Health Services Act (MHSA) Prevention and Early
Intervention Statewide Project funds; however, it also is anticipated that funding will be sought
from other community resources, insuring this is truly a community-supported effort.
These recommendations and strategies are described in more detail beginning on page 63. In
response to public feedback, this document has been designed to provide an overview in the
introduction of the recommendations, followed by the details of how these recommendations
were selected, and culminating in a more detailed explanation of each strategy and next steps.
The Next Steps section of this document begins on page 85.
Please join us in a community-wide education and action campaign to reduce the unnecessary
loss of life from suicides. join us in choosing hope and action over hopelessness and inaction.
You can help by learning about warning signs, reaching out to friends and family who are in
distress with encouragement and information about ways to seek help, breaking the taboo by
discussing suicide, and sharing the most important assets we have as human beings: empathy,
comfort, support for our fellow human beings and the knowledge and ability to act as needed.
Attachment: Santa Clara County Suicide Prevention Strategic Plan (Suicide Prevention Policy)
Attachment: Santa Clara County Suicide Prevention Strategic Plan (Suicide Prevention Policy)
1. Why We Care
Most people are surprised to learn that every year more than one million deaths worldwide are
caused by suicides; and every year there are an additional 10 to 20 million suicide attempts,
often accompanied by serious injuries. Even in our own County, suicide is the leading cause of
death by fatal injury.2 The numbers are truly too large for us to ignore.
While suicide is confounding, suicide is usually preventable, given the right education, services
and supports. Prevention for natural disasters and communicable diseases is typically centered
on risk reduction. Likewise, prevention for suicide must be centered on risk reduction through
a variety of means. Suicide is most often a fatal complication of different types of mental
illnesses which are treatable. Just as with diseases of the body, the earlier treatment is sought,
generally the better the outcome and the lower the risk of other complications. We are
inspired by the success Australia has had in reducing the number of deaths among youth ages
16-24 by 57%3 and of the total national population by 30%4 between 1999-2005. We know that
we, too, can make a difference in reducing suicide deaths in Santa Clara County.
As we did our planning, we learned that most services focus on intervention during a crisis, such
as counseling someone who talks about taking their life, rather than on true prevention and
earlier intervention. Most programs that play a role in preventing suicides do so only indirectly.
As we did our research, it became clear that an effective community suicide prevention effort
must consist of multiple strategies that knit together a comprehensive effort to impact suicide
through broad, community-level education, public policies, formal media communication
practices, and an array of coordinated and accessible culturally and socially relevant services.
Fundamentally, the most significant prevention strategy is for a troubled person to be able to
seek help and talk about how they are feeling with someone they trust. Offering this support
and encouragement to get help is something we are all capable of doing. (Suicide and Crisis
Services (SACS) Hotline, Toll-Free 1-855-278-4204; National Suicide Prevention Lifeline - 1-800-
273-T ALK [8255]).
The Impact of Suicide in Santa Clara County
An important step in our process was
gaining an understanding about suicide in
Santa Clara County.
In 2007, the most recent year for which this
data is available, the suicide rate in Santa
Clara County was 7.8 per 100,000.5 In
contrast to the 7.8 suicide rate, the
homicide rate in the same year was 2.6 per
100,000.6 Many more people kill
themselves than are killed by others and
Santa Clara County
Annual Suicides 1999 - 2007
Number of
Deaths
'99 '00 '01 '02 '03 '04 '05 '06 '07
1999 to 2007
this is consistent with national data that
show suicide is the 8th leading cause of
death in the u.s., compared to homicide
which is the 13th leading cause of death.
The 7.8 per 100,000 suicide rate equates to
140 individuals' who lost their lives in 2007
due to their personal despair and loss of
hope. Among older people (65+ years), the
rate jumps to 14.8 per 100,000.8 Among
males, the rate soars to 18.5 per 100,000.9
In addition, over the period 1999 through
2006, there were 5,971 suicide attempts, an
average of 750 suicide attempts per year.
Most attempt survivors had used poisoning
or cutting/piercing as the means. Whites
lead in the number of attempters (3,435 or
58% of attempters), followed by Hispanics
(1,142 or 19%), and Asians (912 or 15%).
Females attempted at almost twice the rate
of males (3,925 to 2,046). Almost half of all
attempters were in the age group of 21 to 44
years old.
In Santa Clara County, the hospitalization
rate for self-inflicted injury among children
and youth ages 5 to 20 is 30.6 per 100,OOO.lo
This is the rate of self-inflicted but non-fatal
injury hospitalizations and includes suicide
attempts well as self-mutilation. This
equates to more than 100 children and youth
each year who so seriously hurt themselves
or try to kill themselves that they require
hospitalization.
This above data alone should serve as the
community's "wake-up call" because we
knOW, iOO, iflai 30% iO 40% Of persons WFIO
complete suicide have made a previous attempt. Although the majority of people who die by
suicide have not tried before to take their life, nevertheless, a serious suicide attempt is a clear
risk factor for suicide death.ll The risk of completed suicide is more than 100 times greater than
average in the first year after an attempt-80 times greater for women, 200 times greater for
men, 200 times greater for people over 45, and 300 times greater for white men over 65.12
( -.1
Attachment: Santa Clara County Suicide Prevention Strategic Plan (Suicide Prevention Policy)
Attachment: Santa Clara County Suicide Prevention Strategic Plan (Suicide Prevention Policy)
If. What We Did
The Committee Planning Process
The Santa Clara County Suicide Prevention Advisory Committee (SPAC) is a 36-member, broad-
based group of experts in the field; professionals in related fields such as educators and school
administrators, law enforcement, public transportation, public officials, and many others;
specialists in various age groups; mental health consumers and family members from diverse
cultures and backgrounds; suicide attempt survivors; individuals surviving the death of a loved
one by suicide; and concerned members of the public. More than 60% of the members have
personal experience with either the loss of a loved one to suicide or as suicide attempt
survivors. The personal knowledge of loss by suicide infused the committee's efforts with a
particularly deep commitment to saving lives.
The SPAC was formed as a result of a recommendation from the Mental Health Department to
create a local planning group for the purpose of developing a local suicide prevention plan and
the acceptance of this recommendation by the Board of Supervisors' Health and Hospital
Committee at its meeting of September 16, 2009. Already Santa Clara County, like other
California counties, had contributed substantial amounts of its local MHSA Prevention and Early
Intervention funding allocation to the California Department of Mental Health (DMH) to
support state-administered, statewide projects. In December 2008, the Board of Supervisors
assigned S1.9 million in PEI funds to DMH annually for four years. One of these statewide
projects was the development of the California Strategic Plan on Suicide Prevention. The
Strategic Plan was intended to guide the development of future statewide as well as local
suicide prevention efforts. Thus, with Board of Supervisors approval and under the leadership
of the Health and Hospital Committee Chairperson Liz Kniss, the SPAC was established to create
a local Santa Clara County suicide prevention plan.
The SPAC held its first meeting on December 9, 2009. Between December 2009 and May 2010,
the committee met the second and fourth Wednesday of every month. Members of the public
also attended the meetings and their participation was welcomed in all of the discussions and
deliberations, including the "break-out" sessions which followed the whole-group dialogues
and focused on needs and strategies by age categories.
On April 28, 2010, the SPAC"s findings and preliminarily
selected strategies were shared more broadly with the
community at an extensively publicized and well attended
Public Forum. Translators provided live translations from
English into Santa Clara County's additional four
threshold languages (Mandarin, Vietnamese, Spanish and
Tagalog) and one of the break-out groups was conducted
entirely in Vietnamese to better insure that all who
wished to contribute were able to do so.
"'%,
The Mental Health Department website was an important, ongoing communication link
between SPAC members, staff and the public. On the website's Suicide Prevention page,
meetings were publicized; all data and information that was shared at the SPAC meetings were
available on an ongoing basis; and summaries of steps taken and preliminary decisions were
presented. During the six-month SPAC planning period, the website received a total of 4,291
visits for a combined total of 6,954 "views," which is defined as the number of times visitors
viewed particular pages.
The final plan wil( be forwarded to the Santa Clara County Mental Health Board in July 2010 for
its review and further solicitation of public comment. It is anticipated that the plan will be
submittedforreviewbytheBoardofSupervisorsinAugust2010. lmplementationeffortswill
commence after formal approval by the Board of Supervisors.
The Planning Approach
The SPAC members were informed by
the California Suicide Prevention Plan
and studied both its approach and
recommendations. They also were
informed by each other and the vast
experience of the group and other
participants who came to share personal
stories and information. It was clear at
the onset of the planning process that
the work was a matter of the heart as
much as it was strictly an effort in
strategic planning. From the first
evening, members moved through the planning process in a way that honored the deep
emotional impact of suicide while they absorbed data and information and brainstormed about
the needs in our community. This quality within the planning group resulted in guiding values
for the planning work that were arrived at from the beginning of the process.
Guiding Values
1. Suicide is a community problem. It cannot be addressed effectively by only one system or
5. The resulting plan should not duplicate existing efforts but rather leverage them.
6. The community should own this plan.
7. The work must be culturally sensitive and competent.
8. The plan and efforts must be focused on continuous process improvement.
9. It is important that the plan is informed by public input.
Planning Goals
Also, early in the process SPAC members agreed upon the following goals for the prevention
plan:
1. Reduce deaths from suicide in Santa Clara County.
2. Increase awareness of why people contemplate suicide and how to access
available resources.
3. Improve monitoring of suicides using clear and comprehensive data.
4. Empower people to respond to a person who is considering suicide through
training and education.
Conceptual Framework
During the process of developing a planning approach, the committee members were offered a
conceptual framework to assist their thinking about suicide prevention that had proven
successful with the County Mental Health Department's (MHD) public planning efforts related
to the Mental Health Services Act. The approach incorporates a lifespan perspective within an
adapted public health model that aligns a continuum of health needs (in this case suicide) with
levels of promotion, prevention, postvention, early intervention, and intervention strategies.
The postvention strategy'was added to the standard public health model to accommodate a
strategy unique to suicide which is
described below.
This framework allowed the committee
and other stakeholders to consider suicide
prevention needs from multiple
perspectives-age, need and risk,
intervention strategies, and recipient or
target of the strategies discussed.
Public Health Model for
Suicide Prevention Planning:
Working definitions of various types of
interventions were utilized, again drawing
from public health definitions used to
differentiate types and intensities of
Lifiispan
Need and Risk
it)":l' @
Preventio,n
:'Promotion.
interventions. The committee also was informed that, generally speaking, strategies that are
more preventive in nature are usually less expensive per individual served and can reach many
more individuals than intervention strategies. By their nature, strategies that are more
intervention focused serve fewer people for a higher cost per person served.
Promotion. While there is no precise, universally accepted definition of health promotion, the
MHD utilizes the common characterization of promotion as "the enhancement of the capacity
of individuals, families, groups or communities to strengthen or support positive emotional,
cognitive and related experiences."13 Strategies for mental health promotion are related to
improving the quality of life and potential for health rather than amelioration of symptoms and
deficits.
Prevention is concerned with avoiding disease, while promotion is about advancing health and
well-being. Promotion and prevention overlap and should be complementary activities. "To
prevent," of course, means "to keep something from happening." The (nstitute of Medicine
prevention category is divided into three classifications-universal, selective and indicated.
Universal prevention strategies address the entire population (local communities, schools,
neighborhoods). In the context of mental health, selective i:irevention strategies target subsets
of the total population that are deemed to be at risk for mental illness by virtue of their
membership in a particular population segment (victims of child abuse, witnesses to traumatic
events, etc.) Indicated prevention strategies are designed to prevent the onset of mental
illness in individuals who do not meet diagnostic criteria for mental illness but who are showing
early signs of distress (changes in thoughts, emotions or conduct).
Postvention consists ofinterventions after a suicide has occurred aimed at reducing the impact
of suicide on surviving friends and relatives, as being exposed to the death of a loved one by
suicide is itself a risk factor that greatly increases one's risk of suicide, especially in youth. 14
Early intervention involves
identification of warning
signs for individuals at risk for
mental health problems and
intervening early to mitigate
factors that put them at
further risk for developing
mental disorders. Early
intervention can prevent
problems from worsening.
Intervention is used to
describe practices and
programs that are offered to
individuals who are
experiencing health problems
Postvention
Promotion
Institute of Medicine's Adapted Range of Interventions
o
such as mental illness, and typically is associated with "treatment" and ongoing care provided
by practitioners with specialized training in treating health conditions such as mental illness,
substance abuse, and physical illness.
Planning Steps
The planning team designed and facilitated the committee process in a manner that the group
followed ten planning steps in preparing the plan. It was agreed that the initial phase of plan
development would focus on high level
recommendations that would be further shaped into an
implementation plan once approved. The planning steps
are listed below:
1. Established plan goals
2. Identified personal values and guiding principles
3. Reviewed local, state and national data on
suicide
4. Brainstormed needs across the lifespan
5. Aligned needs by age to available data,
risk populations, and potential
strategies
6. Identified additional plan strategies
beyond those that are age and
population-related
7. Organized recommendations into
five overarching strategies
8. Held a public forum for dialogue i
1.
and input on the committee work
9. Incorporated the public input into
the plan
10. Adopted a finalized plan for
Mental Health Board review and
Board of Supervisors approval.
Attachment: Santa Clara County Suicide Prbvention Strategic Plan (Suicide Prevention Policy)
Attachment: Santa Clara County Suicide Prevention Strategic Plan (Suicide Prevention Policy)
Attachment: Santa Clara County Suicide Prbvention Strategic Plan (Suicide Prevention Policy)
m. What We Learned
Committee members learned from members who had first-hand experience with the tragic loss
of life by suicide or attempting their own suicide that language counts.
Language Counts
To ensure the most emotional support
possible, consider the following:
* People "die by suicide" not by
"committing suicide."
There is no "successful suicide" only a
"completed suicide".
There is probably someone in your own
personal network of family and friends
who has first-hand knowledge of the
pain of suicide- regardless of income,
race, or country of origin.
Suicide attempt survivors. Individuals
who have survived a prior suicide
attempt.
Suicide survivors. Family members,
significant others, or acquaintances who
have experienced the loss of a loved one
due to suicide. Among the general public
this term is also used'to mean suicide
attempt survivors.
Suicidal act (also referred to as suicide
attempt). Potentially self-injurious
behavior for which there is evidence that
the person probably intended to kill
himself or herself; a suicidal act may
result in death, injuries, or no injuries.
Suicidal behavior. -A spectrum of
activities related to thoughts and
behaviors that include suicidal thinking,
suicide attempts, and completed suicide.
Resources for immediate assistance for you or
someone you love who is struggling with suicide
or despair
Traditionally, our society has not encouraged open
and honest discussion about suicide and what leads
people to contemplate suicide. Moreover, cultural
norms influence how we communicate about suicide,
and these norms can lead to unintended negative
consequences. Wording can communicate our
deepest bias. People who have survived their own
suicide attempts or who are grieving the loss of a
loved one by suicide are acutely sensitive to the
judgments communicated by word choice, for
example:
a People "die by suicide" not by "committing
suicide." The word commit often is associated
with crime or sin.
a There is no "successful suicide" only a
"completed suicide." Success in our American
culture is an achievement to be celebrated
and applauded. Death by suicide is not a
success, it is a loss.
Language was recognized as affecting a large number
of people. Sixty percent of the committee members,
a broad cross-section of our county, have had
personal experience with suicide and there is
probably someone in your own personal network of
family and friends who has first-hand knowledge of
the pain of suicide-regardless of income, race, or
country of origin.
The committee adopted the language that the
developing field of suicidology is promoting and
recommending. Additional guidance and resources
are provided in the insert to the left, Language
Counts.
:I
o
0
Loco/ and National Data
It is evident that individuals or a group cannot meaningfully "fix" a problem they do not fully
understand. With this understanding, the committee Co-Chair Vic Ojakian led the group in a
review of who dies by suicide, what common problems the suicide victims faced, other risk
factors, and warning signs. While many of the committee members have significant experience
and expertise in some aspects of suicide and with certain age or other population groups, the
data review process gave everyone a similar foundation of basic knowledge. Several questions
were considered as data was reviewed, including:
1. Who is dying by suicide?
2. Who is at risk of suicide?
3. Whatfactorsmaycontributetosuicide?
4. What are the warning signs of suicide?
5. What factors may protect against suicide?
6. What resources are available in our community to address suicide and suicide risk?
7. What do experts recommend are "best practices" in suicide prevention?
8. What are the critical needs and recommended strategies for our community?
In keeping with the overall planning approach, an emphasis was placed on studying suicides
and contributing factors by age groups across the lifespan. Other data provided information
about suicides by gender, race and ethnicity, and various categories of high risk. While
available data was limited, further collection and analysis will continue during the Plan
implementation phase.
For example, it was learned that Santa Clara County was selected as one of three sites in
California to participate in a California Violent Death Reporting System.l5 A 2005 study of these
data revealed that at least one of the following circumstances was identified in 80% of the
suicides:
a The most frequently noted circumstances were associated with mental health problems,
especially for females and young people.
a Females (22%) more often had an alcohol or drug problem than males (14%).
a Malesweremuchmorelikelytohaveajobproblem(10%)thanwerefemales(0%).
n Ma(e suicides were twice as likely to be precipitated by intimate partner relationship
problems (18%) than female suicides (9%).
a Suicide victims ages 45 and older were more likely to have a physical health problem
that contributed to the suicide (38%) than victims under age 45 (6%).
o
In addition to research and review of available data, the committee also discussed the lack of
many types and categories of data that would better inform professionals as well as the public
about danger signs. One of the committee's five key recommendations supports ongoing data
Packet Pg. 533
collection and efforts to encourage more detailed recordkeeping, data analysis, and availability
of information related to suicides.
SuicidebyAge
Children and Youth. In 2005, 270 children (ages 20
through 14) in the u.s. completed suicide.l6 Suicide is the
fourth leading cause of death among children between the
ages of 10 and 14 years.' Between 1999 and 2007, nine
10 to 14 year olds in Santa Clara County died of suicide.l8
Youth and Young Adults. In Santa Clara County, among
teenagers ages 15 through 19, suicide is the third leading
cause of death.l9 Santa Clara County's 2005-07 suicide
rate average among youth ages 15 through 24 was 7.0 per
100,000.2o That is consistent with national figures, as
shown in the box
on the following
page.2l For the nine year period 1999-2007, 113 Santa
Clara County youth (15-24 years old) died of suicide, the
majority, almost 75%, were males.22
Nationally, suicide is the second leading cause of death
among college students.23 College students have an
"increased incidence of depression," according to a
study from the Suicide Prevention Resource Center.""
Another study reports that "students experience more
stress, more anxiety, and more depression than a
decade ago. Some of these increases were dramatic.
The number of students seen each year with depression
doubled, while the number of suicidal students tripled,
and the number of students seen after a sexual assault
quadrupled."25
However, while some college-related factors may
contribute to suicidal behavior, it is important to note
that same-aged youth who are not in college are actually
at a higher risk for suicide attempts than are college
students.26
Adults. The largest number of deaths by suicide occurs
in the adult age group. It is also our county's largest age
group (25-65 year olds) at 55.6% of the total population.
Among that group (ages 26 through 59), the biggest number occurs in the 45 to 54 year-old
category, according to national data. This equates to 7,426 deaths or a rate per 100,000 of
17.19.2' For adults, there is a "clear and direct relationship between suicide and
unemployment. At the individual level, unemployed individuals have between two and four
times the suicide rate of those employed."28 For the nine year period 1999-2007, 810 Santa
Clara County adults (25 through 64 years old) died of suicide, the majority, almost 75%, were
males.29
Older Adults. National data show that the elderly comprise 12.6 percent of the population yet
account for 16 percent of suicides. However, even this may not reflect the true total. Suicide
by senior citizens is thought to go unrecognized more than with other age groups. For the nine
year period 1999-2007, 203 older adults (25-64 years old) in Santa Clara County died of suicide,
the majority, almost 75%, were males.3o
Older white men have the highest suicide rate of all age groups. Among males, adults age 75
years and older have the highest rate of suicide (rate 37.4 per 100,000 population).31 Most
elderly suicide victims are seen by their primary care provider a few weeks prior to their suicide
attempt and diagnosed with their first episode of
mild to moderate depression.32 COtjNTY SUICIDE DEATHS BY RACE/ETHNICITY
Total Su/cide Deaths In 2007: 140
Suicides by Lesbian, Gay, Bisexual and
Transgender individuals
M
The majority of research on lesbian, gay, and
bisexual people who attempted suicide concludes
that young LGBT people have a significantly
higher risk of attempting suicide than
heterosexual young people and that most
attempted suicides among LGBT people occur
during adolescence or young adulthood.33 34
Suicide attempt rates (over the course of a
person's lifetime) range from 52.4% (9th and
12th grade) for lesbian and bisexual females to
29% for gay and bisexual (9th and 12th grade) males."s This is in comparison with heterosexual
suicide attempt rates of 4.6%, according to the National Comorbidity Survey.""' Nationally, LGB
teenagers have been found to be more than three times (3.41) as likely to attempt suicide as
other youth, and young men are at particular risk.37 0ne significant factor that may increase
this risk is the stigma around LGBT identity and the fear of being "found out." These youth
experience a perceived or actual loss of a peer group or of family support resulting in social
alienation from the groups that might otherwise provide protective support.
There has been a paucity of data examining the high vulnerabi(ity of LGBT youth to suicide
attempts. This lack of data demonstrates the need for further assessment from both a public
health and a social justice perspective. An understanding of the impact of isolation from peers
Packet Pg 535
and family and the attendant shame and low self-esteem experienced by LGBT youth also may
provide insight into the risk of suicide for other groups of youth experiencing social alienation
and a lack of family/community support.
Suicides by Race and Ethnicity
In the developing field of suicidology, little is known of how everyday stressors such as racism
can impact a group or individuals. That said, according to the available data reviewed, suicide
rates vary by race and ethnicity. In Santa Clara County, the suicide rate for Blacks/African
Americans is 15.0 per 100,000, American Indians/Native Americans is 13.0 per 100,000, Whites
is 10.7 per 100,000, 2 or more races is 9.3 per 100,000, Asian is 5.2 per 100,000 and Hispanic is
5.1 per 100,000.38
However, these data only provide a partial picture. The table below compares data on Santa
Clara County's racial and ethnic diversity to the percentage of total suicide deaths in Santa Clara
County in 2007. While the rates of suicide are probably underreported, combined we begin to
see a fuller picture of our county in relation to suicide risk.
Oqip@riiq6'%.b,le -jbetwqen racial and ethnjc rpake=up of'Sant4 C3,4i'Q§.iirit.y as,a
pa@re,@njQgeof'p6'palatiori and as a percenjage of total su.tcia#.:a#qiffis=g' ., %-
83(B 34d ethnicity Total percentages of Santa Clara Percentages of total suicide deaths
County population 2007 in Santa Clara County 2007
White 47.1% 57.1%
Asian 26.9% 17.9%
Hispanic 25.4% 16.4%
Black/AfricanAmerican 2.6% 5%
20rmoreraces 2.4%- 2.9%
Americanlndian O.4% 0.7%
Hawaiian/Pacificlslander O.7% O.O%
Suicides by Gender
A woman takes her own life every 90 minutes in the u.s., but it is estimated that one woman
attempts suicide every 78 seconds.
* Women attempt suicide three times as much as men.
* The higher rate of attempted suicide in women is attributed to the elevated rate of
mood disorders among females, such as major depression and seasonal affective
disorder.
Although women attempt suicide more often, men complete suicide at a rate four times
that of women.
More women than men report a history of attempted suicide, with a gender ratio of 2:1.
Firearms are now the leading method of suicide in women, as well as men.
* Suicide is more common among women who are single, recently separated, divorced, or
widowed.
The precipitating life events for women who attempt suicide tend to be interpersonal
losses or crises in significant social or family relationships.=o (.-
Suicides by City
These data are based on zip code data being correlated to city boundaries as closely as possible.
Please note that zip code and city boundaries are not always contiguous and that there may be
some inaccuracies for this reason. Nevertheless, it is informative to look at suicide rates by
Santa Clara County cities. This reveals that the relationship of socioeconomic status and suicide
is not clear. It might be expected that structural social inequalities, which result in groups of
people with poor access to resources, including social capital, would lead to higher rates of
suicide, since this occurs for other indicators of poor physical and mental health. However,
data reveal that the highest rates of suicide appear to be in higher income areas of the county,
with the highest rates of suicide being in Palo Alto, Los Altos/Los Altos Hills, Sunnyvale and
Morgan Hill; while lower rates in general are in Milpitas, Santa Clara and San lose. However, a
closer look at suicides by zip codes reveals that frequent numbers of suicides are found in both
higher income areas as well as in certain lower income neighborhoods.
Please see Attachment 1 in the Appendix for numbers of suicides by zip code and a comparison
of suicide deaths with homicides.
Table 1. Suicide Rates by Santa Clara County Cities, 2000 - 2006
During the seven years that were reviewed, 2000 through 2006, certain zip codes more
frequently had higher numbers of suicides, for example, 95086 and 95123. It is unclear, what, if
any, these zip codes have in common. Would the pattern hold over a longer period of analysis?
Much work remains to be done to more fully understand the dynamics of suicide.
Suicides among Custody Populations
Several interesting questions are raised when reviewing data about suicides among in-custody
populations. For example, youth entering juvenile facilities are at greater risk of suicide than
similar youth in the u.s. population; however, the suicide rate in u.s. juvenile facilities in 2002
was nearly equal to the rate for similar youth in the general population.
The presence of increased risk factors among juvenile justice-involved youth can be confirmed
with Santa Clara County data. Emotional problems were cited as the most significant
underlying factor contributing to their delinquency by both boys and girls in custody with the
Santa Clara County Probation Department. Forty percent of boys and 58% of girls in custody
said "something very bad or terrifying" had happened to them. Nearly one-quarter of all girls
surveyed as they entered juvenile hall said they wished they were dead.4l Of all boys
interviewed, 81% had one or more trauma factor noted, compared to 91.7% of the girls.""
Among out-of-custody boys on probation supervision, 95.6% had at least one trauma factor
noted, while more than one-quarter (26.7%) of boys had three or more trauma factors noted.
However, a// girls reported at least one trauma factor, and 72.7% noted four or more trauma
factors in their histories.43
How does this translate into suicides or attempted suicides? According to the Santa Clara
County Probation Department's Institution Incident Report database, which was first
implemented in September 2004, there have been no deaths by suicide during the period since
then among youth in custody. The decrease in suicide attempts is attributed to changes made
in overall custody program and protocol, as well as changes made to the suicide risk protocol
and response by the Mental Health staffin the Hall. Mental Health staff and Probation Juvenile
Hall staff have received more training in trauma-informed care and all staff members are
involved in increased care coordination for youth considered at risk.
Suicide attempts by youth in custody were as follows:44
Youth in Santa Clara County Probation Department Custody
Year Number of Attempted Suicides
2004 7
2005 39
2006 11
2007 5
2008 0
2009 3
Total 65
:l
o
0
Nationally, the suicide rate in jails has decreased 70% from 1983 to 2003 and has decreased
50% in prisons over the same time period. In 2002 the suicide rate in local jails (47 per 100,000
inmates) was more than three times the rate in State prisons (14 per 100,000 inmates)."s
However, the suicide rate in both settings remains high.
d
lii California, between 2001 and 2006, there were
190 suicides by inmates in California. This is far
fewer than the number of deaths by illness but
much greater than any other cause, including more
than double the number of homicides.""
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In Santa Clara County, during the years 2000
through 2009, there were 212 suicide attempts in
the Main Jail and 81 suicide attempts at Elmwood.
During that same time period, there were 12
completed suicides in the Main Jail and two
completed suicides at Elmwood.4'
among active duty Sailors.""g
Suicides by Military Personnel-Active-Duty,
National Guard, Reservists and Veterans
With our nation's current level of international
military engagements, the active-duty military
personnel, National Guard, reservists and veterans
are another group identified as facing higher risk
for suicide. The number of suicides among active-
rliity personnel has been rising, with 147 reported
suicides in the Army from January through
November 2009-an increase from 127 in the same
period of 2008. Among non-active-duty reserve
soldiers, 50 suicides were reported in 2008; but the
number had risen to 71 during the first 11 months
Of 2009,""
The Navy reports "For the past 10 years, it (suicide)
has been the second or third leading cause of death
According to "Suicide Rivals The Battlefield in Toll on u.s. Military" by Jamie Tarabay as
reported by National Public Radio on June 26, 2010, "Nearly as many American troops at home
and abroad have committed suicide this year as have been killed in combat in Afghanistan.
Alarmed at the growing rate of soldiers taking their own lives, the Army has begun investigating
its mental health and suicide prevention programs." However, the article goes on to say that
the tough challenge is "changing a culture that is very much about 'manning up' when things
get difficult."
Other experts agree that, similar to the general public, one of the main reasons that military
personnel do not seek help with mental and emotional health issues is due to stigma and fear
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that seeking help will negatively impact their
careers. "A study published in the New
England Journal of Medicine in 2004 showed
that of those active duty service members
who screened positive for a mental health
problem (PTSD, major depression,
generalized anxiety disorder), only 23-40%
sought mental health care. Perceived
barriers to seeking treatment included fear
of being seen as weak, of being treated
differently by unit leadership, and of other
members of their unit having less confidence
in them."so
Correspondingly, veterans, regardless of
when they served or in which branch, are
twice as likely as the general population to
die by suicide, according to an article in the
Journal of Epidemiology and Community
Health (July 2007).51 Suicides among United
States military veterans ballooned by 265
from 2005 to 2007, according to statistics
released by the Veterans Affairs (VA)
department. The VA estimated that in 2005,
the suicide rate per 100,000 veterans among
men ages 18-29 was 44.99, but jumped to
56.77 in 2007.52
"Of the more than 30,000 suicides in this
country each year, fully 20% of them are acts
by veterans," said VA Secretary Eric Shinseki.
"That means on average 18 veterans die by
suicide each day. Five of those veterans are
under our care at VA." Suicide rates among
veterans in all four branches of the military
service are significantly higher than in the
general population.53
Veterans are more likely than the general
public to use firearms as a means for suicide.
"The odds of firearm use (among suicide
decedents) among male and female veterans
were 1.3 and 1.6 times higher, respectively,
than among their nonveteran counterparts
after adjusting for age, marital status, race and region of residence." 54
u.s. Census data show there are 106,430 veterans in Santa Clara County.ss Approximately
40,000 of that number are veterans of the Vietnam-era service, however, the theaters of
service for an increasing number are Iraq and Afghanistan.
Data compiled for the Veterans Administration Palo Alto Health Care System show that among
its patients there were 126 suicide attempts and 1 completed suicide from October 2007
through September 2008.. There were 96 suicide attempts and 7 completed suicides from
October 2008 through September 2009. There were eight attempts and zero completed
suicides in December 2009 alone.
Other Possible Correlations: More Data Is Needed
Varying levels of forensic analysis often may be needed to determine if a death was caused by
suicide, homicide, accident or natural causes. More extensive collection, maintenance and
analysis of data related to suicides will be key to ongoing efforts to effectively prevent suicides
and to decision-making about where to allocate prevention resources.
Suicides by Occupation. Dr. John Q. Baucom, Ph.D., writes in his book, Fatal Choice, "More
professionals commit suicide than others. Farm workers have the lowest incidence among
occupational groups. Dentist and physicians take their lives at the rate of 6% to one over the
general population. Lawyers commit suicide at a ratio of five to one over the general
population." A web site, straightdope.com, cites an unnamed California study which found that
dentists were surpassed in suicide rates only by chemists and pharmacists. Presumably, a
Washington State study found that dentists had a suicide rate second only to sheepherders and
woolworkers. However,ourreviewcouldnotsubstantiatethatthesedataareaccurate.
One of the largest studies on this topic was conducted by the National Institute of Occupational
Safety and Health (NIOSH) in 1995, which concluded that the medical field definitely has a
higher suicide rate. But beyond that, NIOSH researchers said the picture is equivocal: Often
the studies are only of one geographic area, sometimes they have methodological problems,
and sometimes they contradict each other.
In another study, a sociology researcher at the University of California, Riverside, Augustine
Kposowa, Ph.D., looked at records over nine years for about half a million people of whom 545
died by suicide. After controlling for such variables as age, income, race, marital status and
region of residence, he found that only laborers and the unemployed had significantly higher
risks. On the other hand, he found "dramatic" differences for suicide among the industries
where people work. At highest risk were those in mining, business and repair services,
wholesale and retail trade and construction. Again, which, if any, of these data are accurate is
unclear and there is no data to examine whether these conclusions apply to Santa Clara County.
Police-Involved Suicides. Some of the first research into "suicide by cop" was completed by
Sgt. Rick Parent of the Delta Police Department in British Columbia. Parent's research of 843
police shootings determined that about 50% were victim-precipitated homicide. Police defined
victim-precipitated homicide as "an incident in which an individual bent on self-destruction
engages in life threatening and criminal behavior to force law enforcement officers to kill
them."s" Again, further research is needed to determine the extent to which this type of suicide
occurs in other locations.
Suicides by Police Officers. Research has been limited; but there are some indications that
there are approximately 450 law enforcement suicides per year nationally, versus 150 officers
who die annually in the lines of duty.s"
Suicides Labeled as Auto Accidents. The real
percentage of suicides among car accidents is not
reliably known, Studies by suicide researchers
indicate that "vehicular fatalities that are suicides
Vary from 1.6% [0 5%." Same Su!C!deS are
misclassified as accidents because suicide must be
proven. "It is noteworthy that even when suicide is
strongly suspected but a suicide note is not found,
the case will be classified an accident." 58 59
Some researchers believe that suicides disguised as
traffic accidents are far more prevalent than
previously thought. One large-scale community
survey (in Australia) among suicidal persons
provided the following numbers: "Of those who
reported planning a suicide, 14.8% (19.1% of male
planners and 11.8% of female planners) had
conceived to have a motor vehicle "accident." Of all attempters, 8.3% (13.3% of male
attempters) had previously attempted via a motor vehicle collision."6o
Other Misidentified Suicides. It is unknown how many suicides are not classified as intentional
deaths on their death records. However, some means of suicide are believed to be more
commonly unreported. For example, it is believed that some portion of fatal poisonings coded
as unintentional or undetermined are actually suicides. Under-reporting of suicide has been
attributed to factors such as pressure from families and subjectivity among coroners and
medical examiners. As compared with firearms and suffocation, suicide by poisoning is
considered to be particularly susceptible to underreporting. The rapid rise in unintentional
poisonings in recent years has led some to wonder whether part of this increase represents
misdiagnosed suicides.6l
Suicide Clusters and Suicide "Contagion." A suicide cluster is defined as multiple deaths by
suicide that occur within a defined geographical area and fall within an accelerated time. These
clusters consist of more than three victims, typically ranging from 13 to 24 years old, and occur
[I
within approximately a one-to-two-year period. Contagion is the process in which the death by
suicide of an individual influences an increase in the suicides of others. Exposure to another
individual's suicide can precipitate imitative
suicidal behavior.62
How impactful exposure to suicide is as a
risk factor for suicide is an active area of
research. A 1996 study was unable to find a
relationship between suicides among
friends,63 however, a 1986 study found
clusters of suicide among teenagers
following the televising of news stories
regarding suicide. These clusters are
thought to account for 5% of teenage
suicides.s"
Between 1984 and 1987, journalists in
Vienna covered the deaths of individuals
who jumped in front of subway trains. The coverage was Bxtensive and dramatic. In 1987, a
campaign alerted reporters to the possible negative side effects of such reporting and
suggested alternative strategies for coverage. In the first six months after the campaign began,
subway suicides and nonfatal attempts dropped by more than 80%. The total number of
suicides throughout Vienna dropped as well.ss
The Centers for Disease Control and Prevention (CDC) reports that suicide clusters account for
100-200 deaths annually. Suggestions for minimizing suicide contagion include understanding
the "circles of vulnerability" in order to identify those most at risk after a suicide has occurred
in the community. "Circles of vulnerability include individuals who:
a Had a negative interaction with the victim shortly before the suicide occurred and who
perhaps even encouraged it
Were in a suicide pact but backed out at the last minute
Realize now that they missed the obvious warning signs of suicide
Were suicidal at another time, regardless of whether they had know the victim
Have mental health problems."66
o
Homicide-Suicides. Murder-suicideperpetratorsappeartobevastlydifferentfrom
perpetrators of homicide alone. Whereas murder-suicide perpetrators were found to be highly
depressed and overwhelmingly men, other murderers were not generally depressed and were
more likely to include women in their ran,ks."z
Suicide Risk and Mental Illness
Of the 14.8 million Americans who live with
depression, the majority will not attempt suicide.68
However, research has shown a definite correlation
between depression and suicide, as well as a
significant association with all mood disorders and
suicide. Varying studies have shown that between
60% and 90% of suicide victims had a psychiatric
illness at the time of their death. Most common
are mood disorders (depression, bipolar disorder, borderline personality disorder, etc.) and
substance abuse.69 7o '1 72 73 When both mood disorders and substance abuse are present, the
risk for suicide is much greater, particularly for adolescents and young adults.74
Children and Youth. Among Santa Clara County parents who participated in a 2006 survey
commissioned by the Lucile Packard Foundation for
Children's Health, 5.8% were "very concerned" about
their child's level of depression and an additional 14.1%
were "somewhat concerned.""s At the same time, one-
quarter to one-third of seventh, ninth and eleventh
graders reported symptoms of depression (feeling so sad
or hopeless for at least two weeks during the previous
year that they stopped doing some regular activities).'6
Further, 16.3% of the seventh, ninth and eleventh
graders
reported
they seriously considered, and 8.2% reported
they actually attempted, suicide during the
previous year."
Nationally, more teenagers die by suicide than
from cancer, heart disease, AIDS, birth defects,
stroke, pneumonia, influenza, and chronic lung
disease combined.78
Young Adults. Some experts estimate that
about 25% of all young people suffer from
depression by the time they are 24, however,
very few seek help. Depression affects one out
of six college students; and, as mentioned
previously, suicide is the second leading cause
of death among college students.79 Again,
same-aged youth and young adults who are not
in college are actually at a higher risk for suicide
Factors that May Contribute to.Suicidal
Behavior among Young Adults Transiti6ning to
Financial Independence
Major life transitions, such as Ieaving%'7ermeffTh't;-
the first time, may exacerbate exisj..irqg
psychological difficulties or trigger-new orjp5.
Real or perceived stress may contribute to fee
development of stress disorders-including
suicidal behaviors.
Parental pressure to succeed academically or
professionally
Economic pressure to successfully complete a
course of education and training in a shorter
iperiod of time may increase stress.
=ry'lounting financial burdens, worries about time
away from careers and being out of the
y,pr)kBlage,.and uncertainties about the future
"j6h)ljir':t,(.especially for those pursuing
' rl%eq.p,ch,and aca,demic careers) are additional
, s'b.p-eQ6rs4r::studQpis in college, graduate
attempts than are college students. 8o
Adults. In 2005, California Health Interview Survey data showed that 18% of adults in Santa
Clara County reported they needed
help for emotional or mental
problems; however, only 8% of adults
had seen a health professional for
these problems.
A review of Santa Clara County
Mental Health Department Call
Center records show that less than
30% of the people who seek services
from the Department's system
receive mental health treatment.
Coupled with this, a large-scale
epidemiological study shows that less
than 30% of people with psychiatric
disorders seek treatment.8l Taken
together-less than 30% of those
who need services seek services -
and-less than 30% of those who
seek services receive services-it is
readily apparent that there is a
significant unmet need for mental
health treatment, including
depression and additional mood
disorders among others.
Older Adults. Depression, one of the
conditions most commonly
associated with suicide in older
adults,82 is a widely under-recognized
and under-treated medical illness.
Studies show that many older adults
who die by suicide-up to 75%-visited a physician within a month before death.83 These
findings point to the urgency of improving detection and treatment of depression to reduce
suicide risk among older adults.
In today's society older adults are at risk for isolation, loneliness, and depression as their family
members move away and they leave the workforce. A recent study of Santa Clara County older
adult participants in congregate nutrition programs found that the primary reason for
participation in the program is socialization.84 In 2006, 16.2% of Santa Clara County adults age 65
and older reported having one or more days per week when their mental health was not good.ss
In addition, in Santa Clara County, one-fourth of seniors are also caregivers. Caregivers are at
high risk for depression, with approximately 11% of full-time professional caregivers reporting a
major depressive episode in the past year compared to 7% for all occupations.86 Studies show
that 16% of caregivers report a decline in their health after taking on the caregiver role, and
about half of caregivers who care for someone with Alzheimer"s disease develop psychological
distress.
Lesbian, Gay, Bisexual, Transgender Individuals. Depression and suicide also appear to
significantly affect members of the LGBT community. A Santa Clara County 2005 Lesbian Gay,
Bisexual and Transgender Needs Assessment and Report on Emotional Well-Being and Mental
Health was conducted and prepared by the Billy DeFrank LGBT Center. Among respondents,
22% stated that within the past year they needed help for depression and 7% said they needed
suicide prevention help.
Military Personnel -Active Duty, National Guard, Reservists, and Veterans. Although local
statistics on mental illness and co-occurring disorders among veterans are scarce (i.e., the Mental
Health Department does not capture data on veteran status), the high incidence of mental illness
among veterans is well documented by other sources. The National Alliance on Mental Illness
(NAMI) Veterans Resource Center reports that more than 100,000 combat veterans sought help
for mental illness since the start of the war in Afghanistan in 2001, about one in seven of those
who have left active duty since then, according to VA records. Almost half were PTSD cases.87
The total of mental health cases among war veterans grew by 58% from 63,767 on June 30, 2006,
to 100,580 on June 30, 2007, VA records show. The mental health issues include PTSD, drug and
alcohol dependency, and depression.88
Recent data from the Defense Medical Surveillance System from self-assessments since 2005 of
service members who served in Iraq show that 50% of US Army National Guardsmen and some
45% of US Army and Marine reservists have reported mental health concerns.89 0f all those
using VA health care, 30% suffer from depressive symptoms, two to three times the rate of the
general population.9o
Again, it is critical to review statistics about depression with the knowledge that research has
shown up to 90% of people who kill themselves have depression and/or another diagnosable
mental or substance abuse disorder with a depressive component.9l With this in mind, it is
particularly alarming to recognize that more American adults suffer from depression (14.8
million)92 than coronary heart disease (7 million), cancer (6 million) and AIDS (200,000)
combined.93
Suicide Risk and Alcohol Consumption
In Santa Clara County, 17.6% of adults responding to the Public Health Department's Behavioral
Risk Factor Survey engaged in binge drinking within the previous 30 days, and 2.7% of the
respondents' answers classified them as heavy drinkers or at risk of heavy drinking patterns.g=
I
Among the many other reasons this is worrisome (liver and heart disease, increased chances of
certain cancers, etc.), alcohol dependence is an important risk factor for suicidal behavior.
Suicide completers have high rates of positive blood alcohol, and intoxicated people are more
likely to attempt suicide using more lethal methods. Further, alcohol may be a significant factor
in suicides among individuals with no previous psychiatric history.gs It has been found that
alcohol intoxication increases suicide risk up to 90 times, in comparison with abstinence.96
Alcohol is involved in an estimated 30% of suicides.97 Alcohol causes depressed mood, lowers
inhibitions, and impairs judgment, any or all of which may make vulnerable people more likely
to act on suicidal plans. These same factors (lowered inhibition and impaired judgment) are
also associated with domestic violence and abuse, other factors that are believed to increase
the likelihood that suicide will occur.
Suicide Risk Factors and Warning Signs
Experts tell us that there are many circumstances
that can contribute to someone's decision to end
his/her life, but a person's feelings about those
circumstances are more important than the
circumstances themselves. All people who consider
suicide feel that life is unbearable. They have an
extreme sense of hopelessness, helplessness, and
desperation. In addition, with some types of mental
illness, people may hear voices or have delusions
which prompt them to kill themselves. If you or
someone you know experiences these, there are
services that can provide support and guidance:
National Suicide Prevention Lifeline- 1-800-273-TALK
(8255) and Santa Clara County's Suicide and Crisis
Services (SACS) 24-Hour Crisis Hotline: Toll-Free 1-
855-278-4204.
recurrence of significant stressful life events, should lead to strengthened social support.
In addition to risk factors, a number of organizations devoted to suicide prevention publish lists
of warning signs, with the objective of helping people recognize common indicators in order
that they can offer support and assistance that will cause the person to reconsider their suicidal
plans. Among the many such organizations that have developed warning sign lists are
Suicide.org, American Foundation for Suicide Prevention, SAVE (Suicide Awareness Voices of
Education), Centers for Disease Control and Prevention Injury Center, American Association of
Suicidology, and the National Suicide Prevention Lifeline.
Factors That May ProtectAgainst Suicide
Protective factors buffer individuals from suicidal thoughts and behavior. To date, protective
factors have not been studied as extensively or rigorously as risk factors. Identification and
understanding of protective factors are, however, equally as important as research concerning
risk factors. Identified protective factors against suicide are:
ffl Effective clinical care for mental, physical, and substance use disorders
a Easy access for a variety of clinical interventions and support for help-seeking
s Restricted access to highly lethal means of suicide
Strong connections to
family and community
support
n Support through ongoing
medical and mental health
care relationships
a Skills in problem solving,
conflict resolution, and
nonviolent handling of
disputes
u Cultural and religious
beliefs that discourage
suicide and support self-
preservation.98
Young at Heart
I am 65 years old and I have been severely depressed for at least 6o of
them. My parents have been positive I carried some "family genetic defect
that goes back for over 120 years." They said as much to me and calling me
a "nasty little son of a bitch". They abused me emotionally and sexually and
made me feel responsible for it and eventually made me available to a
homosexual man. I never was able to overcome the personal stigma and
emotional breakage I suffered then or the power my mother held over me
untilI was almost 6o when I finally gave up and tried to kill myself. I
suffered in every way possible duringthose years-not being able to finish
college, and being u.nable to hold a decent job for many years. I had to rely
on my parents for support, which only helped me in one way. My mother
kept me in virtual servitude, even when'l finally did get a }oti.
The gist ofthis is that the emotional breakdown I suffered so many years
ago lasted until I was past 6o when, to get away my horrific memories and
the constant badgering of my mother, I made two nearly completed suicide
attempts, which finally got me into the Barbara Aarons Wing at Valley Med
Center and into quality psychiatric care. I even "graduated" from Catholic
Charities' FSP 01derAdult program almost a year ago. I finally learned that I
was not responsible for the things that happened to me and that I might
just have been sane in an insane world or family. I am well, with my
medication and occasional adjustments to it. Now, I am a 65 year old
adolescent looking forward to life.
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IV. Review and Summary of Local Needs
The committee and staff members' research on suicide risk factors, populations at high risk,
available resources, and effective programs is consistent with the American Foundation for
Suicide Prevention's Best Practices Registry recommendation for a data-driven planning process
that "typically will involve multiple stakeholders in a process of assessing local needs, assets,
and readiness, and choosing interventions that match local problems and circumstances."
Local Needs across the Lifespan
The SPAC members agreed to utilize age groupings that worked well in the Mental Health
Department's Mental Health Services Act (MHSA) planning processes. These groups are:
1. Children and Youth Ages 0 through 15
2. Youth and Young Adults Ages 16 through 25
3. Adults Ages 26 through 59
4. Older Adults Ages 60 and over
5. Strategies Applicable Across Age Groups.
The charge of the SPAC was to examine the risk factors most prevalent within each of the age
groups that may contribute to the consideration or decision to take one's own life; second, to
match each of these age groups with targeted high risk sub-groups or "priority populations"
among those age groups based on the data review; and third to recommend strategies most
appropriate to diminish risk among that population group/s in the context of Santa Clara
County's demographics. A simple "logic model" was utilized for the work:
Agree
on needs
related to
e(ik:ide risk
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needs mth
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data
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po pulaUons
R=ommend
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prevention
sQatqgiep
The SPAC members devoted a portion of each meeting to discussions in break-out groups by
these age categories. For each age category, the Identified Needs and Concerns were derived
from discussion of known suicide risk factors and identification by committee members of the
highest priority needs and concerns to be addressed in Santa Clara County. Likewise, the
Recommended Priority Populations reflect examination of data and decisions about which
groups within each population category are at highest risk or highest need for focused
prevention and intervention efforts.
Finally, the Recommended Strategies were developed to respond to the Recommended Priority
Populations and were selected based upon reviews of effective and promising programs and the
insights and expertise of the SPAC members. While priority populations were the focus, it was
with the understanding that prevention strategies that reduce the suicide risk for high-risk groups
also will provide the benefit to the general population.
Children and Youth Ages O through 15
1. Identified Needs and Concerns
Inadequate sense of control in a life phase when youth have limited control over their lives
Difficulty accessing available mental health services, education and support to prevent substance abuse
Lack of strong resiliency skills to cope with failure and disappointment, bullying, and breakups
Inadequate defined support, connections to community, unconditional acceptance, and sense of
communal responsibility for safety
Low feelings are perceived as abnormal
Lack of self-esteem, sense of accomplishment, and sense of hope
Lack of respect for peers, adults, and themselves
2. Recommended Priority Populations
Children and youth experiencing:
a Academic difficulties; changing schools; life milestones
a Immigration concerns; refugee experience; acculturation stress; linguistic and/or cultural differences
ffl Trauma (sexual, physical, emotional, exposure to violence)
s Suicide of friends; suicide attempts; mental illness; substance abuse
s Separation from family; homelessness
Juvenile justice/foster care system involvement
Gender identity issues-lesbian, gay, bisexual, transgender, queer, or questioning
Neglect and/or without nurturing adult
3. Recommended Strategies
Accessible mental health counselors in schools
Screenings of youth for risk of suicide and other mental health concerns
Targeted counseling for youth who have lost a loved one to suicide
Enhanced mental health resources, school curriculum, and parent initiatives
Identify coping mechanisms, access points, and connectors for youth to address life challenges
Programs to protect youth from social and geographic isolation and barriers to peer interaction
Programs that teach resiliency
Programs and services that enable children and youth to cope with failure and disappointment, bullying,
and breakups
Training for those who interact with at risk youth (community leaders, clinicians, physicians, family
members, police, teachers, peers, and others)
Accessible, youth-centered crisis line; and single, countywide access point/telephone number for youth
at-risk
Provide teens with support groups for youth dealing with teen suicide
Provide prevention opportunities: Youth to become engaged in public service; school staff to be dynamic
and caring; youth centers; develop students' own skills to deal with emotional challenges.
Educate parents and foster parents to recognize a child's emotional needs and know the resources
available to assiSt when child is in crisis.
Publicly recognize individuals who connect people at risk of suicide to resources
Ensure post-incident care for individuaJ and fami(y after a 5150 episode (forced admission for psychiatric
observation)
Youth and Young Adults Ages j6 through 25
1. Identified Needs and Concerns
Sense of physical and emotional isolation from family, social network and/or peers
Stigma associated with mental health and substance abuse services and suicide prevention
Inadequate identification of mental health issues by self and others (caregivers, medical providers, etc.)
Paucity of service resources and difficulty accessing age-appropriate and linguistically available services
(inadequate referrals, poor connections, barriers to qualify, difficult to afford, language barriers)
Transitioning between being dependent on others to being financially independent without an adequate
support network
2. Priority Populations
Young people experiencing:
a Suicide of friends; previous attempts; thoughts of suicide
Academic difficulties; immigration concerns; refugee experience; acculturation stress; linguistic and/or
cultural differences
Transition from dependence to financial and personal independence, regardless of educational level or
pursuits
Trauma (sexual, physical, emotional, exposure to violence)
Mental illness; substance abuse; co-occurring conditions
Homelessness; alienation from family
Juvenile/adult criminal justice involvement; transitioning from incarceration to reintegrating with society
Foster care system involvement
Gender identity issues-lesbian, gay, bisexual, transgender, queer, or questioning
3. Recommended Strategies
Screening and timely intervention of those at risk of suicide
School-based, culturally relevant intervention services, including consultation for educators and parents,
and peer to peer support
Peer stipend program for youth to promote intervention and treatment services
Training, support and educational materials for parents, partners, and family members and educators
regarding safe handling of young adult life challenges and crises (Example: educational suicide help
hotline)
Accessible and comfortable spaces for adults at-risk of suicide, such as a mobile crisis unit, satellite self-
help centers, and/or a community lounge space
Age-appropriate crisis hotline
Support groups for youth dealing with teen suicide
Prevention opportunities, such as youth becoming engaged in public service; school staff to be dynamic
and caring; youth centers; other ways for students to develop skills to deal with emotional challenges
Previous attempters to share their stories to encourage others to seek help and have hope for improved
life satisfaction
Public recognition of individuals who connect people at risk of suicide to resources
Post-incident care for individuals and families after a 5150 episode (forced admission for psychiatric
observation)
[II
Adults Ages 26 through 59
1. Identified Needs and Concerns
Inadequate identification of mental health issues by self and others (peers, medical providers, etc.)
Paucity of service resources and peer support strategy assistance as well as difficulty accessing available
services
Stress associated with life transitions, life events and trauma
Stigma associated with mental health and substance abuse services and suicide prevention
Cultural perspectives on mental health challenges and suicide
Lack of safe welcoming places and opportunities to ask for assistance and services
2. Priority Populations
Adults experiencing:
' Decreased functioning, isolation, disabilities or poor health
Trauma (sexual, physical, emotional, exposure to violence)
Suicide of friends; suicide attempts
Mental illness; substance abuse; and co-occurring conditions
Loss of income and/or a loved one
Criminal justice system involvement
Homelessness
Gender identity issues: lesbian, gay, bisexual, transgender, queer, or questioning
Veterans
3. Recommended Strategies
Screening and assessments for risk of suicide
Support for adults at risk of suicide
Tools to safely handle life challenges and manage crises, such as cognitive-behavioral theory and thought
stopping.
Accessible counseling and crisis services
Mobile crisis unit
Self-help centers in communities
Training, support and educational materials for friends, family members and employers regarding safe
handling of personal challenges and crises, (Example: educational suicide help hotline)
Previous attempters sharing their stories to encourage others to seek help and have hope for improved
life satisfaction.
Collaboration between military personnel, veterans organizations and the Veterans Administration to
make sure all veterans receive services and to design, implement and coordinate the most effective
possible services
Work with business leaders and organizations to promote mental health awareness and education
Pubfic recognition of individuals who connect people at risk of suicide to resources
Post-incident care for individuals and families after a 5150 episode (forced admission for psychiatric
observation)
Packet Pg 555
01derAdultsAges 60andAbove
1. Identified Needs and Concerns
a Inadequate identification of mental health issues by self and others (caregivers, medical providers, etc.)
a Paucity of service resources and difficulty accessing available services (inadequate referrals, poor
connections, barriers to qualify, difficult to afford, lack of transportation)
Loss or diminishment of independence, role, and physical health; loss of loved ones; physical difficulty in
getting to services
Stigma associated with mental health and substance abuse services and suicide prevention
Cultural perspectives on death and dying; differing definitions of a life of value; and cultural taboos
against discussing end of life
Psycho-social stressors can lead to increased risk not only of suicide but of homicide-suicides
2. Priority Populations
Older Adults who are:
Caucasian males
Over 75
Isolated or grieving (widows/widowers), experiencing a loss in relationships or other significant change
Experiencing a loss of sustainable income and/or personal resources
Functioning poorly, have disabilities or poor health
Experiencing immigration concerns; refugee experience; acculturation stress; linguistic and/or cultural
differences
Coping with trauma (sexual, physical, emotional, exposure to violence, veteran)
Mentally ill; abusing medication, drugs, or alcohol
3. Recommended Strategies
Education, informing materials, and consultation support to primary care providers
Depression screening, referral, linkage and follow-up services through primary care providers
Accessible, age-appropriate counseling and treatment services
Accessible senior-focused crisis line; and single, countywide access point/telephone number
Home visitation follow-up services and linkage of homebound seniors to services
Senior-focused intervention for depression, death and dying issues
Public recognition ofindividuals who connect people at risk of suicide to resources
Post-incident care for individuals and families after a 5150 episode (forced admission for psychiatric
observation)
d
Cross-Cutting AllAges
1. Identified Needs and Concerns
Paucity of service resources and difficulty accessing available services
Difficulty accessing available mental health services, education and support to prevent substance abuse
Stigma associated with mental health and substance abuse services and suicide prevention
Cultural perspectives on mental health challenges and suicide
Lack of safe of welcoming places and opportunities to ask for assistance and services
2. Priority Populations
Individuals experiencing:
s Trauma (sexual, physical, emotional, exposure to violence)
ii Suicide of friends; suicide attempts
s Mental illness; substance abuse; and co-occurring conditions
Juvenile/criminal justice system involvement
Immigration concerns; refugee experience; acculturation stress; linguistic and/or cultural differences
Homelessness; significant loss of social and/or economic support
Gender identity issues: lesbian, gay, bisexual, transgender, queer, or questioning
Transitions
3. Recommended Strategies
a Screening and referral resources in primary care and other caregiving settings
ffi Training for professionals, service providers and community members on identification and response to
individuals at risk
ffl Crisis hotline and single, countywide access point/telephone number
Accessible, affordable and appropriate crisis counseling and support services
a Mobile crisis unit
n Self-help centers in communities
a Consultation phone services
a Ensure post-incident care for individuals and families after a 5150 episode (forced admission for
psychiatric observation)
a Public recognition ofindividuals who connect people at risk of suicide to resources
[II
Additional Strategies: Community Education and Information
The committee recognized the importance of broadly increasing knowledge of the risk factors
and warning signs for suicide while promoting help-seeking. By enhancing awareness of
sources of help and reducing stigma associated with seeking help, these activities should
prevent deaths by suicides as well as self-injury while trying to die by suicide. Increased
knowledge has been shown to create substantial change. Mothers Against Drunk Driver's
(MAAD) success in changing drunk driving from a person or family's secret shame into a
community responsibility with their "Friends Don't Let Friends Drive Drunk" campaign is the
recommended model for Santa Clara County's suicide prevention public education campaign.
This strategy will include one universal message for the entire community. In addition, other
targeted measures will be developed to engage smaller groups targeting youth, older adults,
different language speakers, etc.
An educational campaign targeting improved physician assessment for suicidal risk and
management of that risk also is recommended for implementation. Suicide data highlighted
many areas of special concern. One example is data showing that a large portion of elderly
persons who die by suicide had seen a health care professional within a relatively short period
of time prior to their death.
A key concern that was raised by the committee is that in implementing an AdCouncil type
public awareness campaign, these activities should be linguistically and culturally appropriate
for our diverse community. It also should be broad in the means used to communicate. Youth
and young adults are more receptive to internet technologies and social networking. For
seniors, radio or television may be the media of choice. Some immigrant groups get their
information primarily from foreign language radio, television and press. Others look to daily
newspapers or listen to radio. Whatever approach is used, consideration for preferences,
including social media, will be considered to most effectively reach the widest possible
audience.
Additional Strategies: Communication Practices
In addition to reviewing needs of populations from a lifespan perspective, the committee
members explored other critical areas that must be addressed in order to implement an
effective suicide prevention effort in Santa Clara County. The Committee benefitted from
several members who had been addressing the youth suicides in Palo Alto. Lessons learned
include that for any comprehensive suicide prevention campaign to work, two essential
elements should be included in the communication practices: 1) a coordinated communication
strategy, and 2) educating all forms of media-television, radio, print, social network, internet,
and other forms of media concerning the importance of adherence to the guidelines for
reporting deaths by suicide, using the recommendations from the Suicide Prevention Resource
Center's Safe Reporting Guidelines.
While the community education and awareness campaign is its own strategy with the dual
Packet Pg 558
objectives of 1) increasing community awareness of suicide, and 2) encouraging people to seek
help for themselves or loved ones, in is important that it include the establishment of a body
that will have oversight and coordinating responsibility of the Communication Practices Work
Group. The Hroup's role will be to 1) ensure the development of defined, clear, concise,
paradigm-shifting message for all efforts; 2) ensure adherence to the guidelines for responsible
communication on issues pertaining to suicide and that messaging is consistent across all media
campaigns and efforts; 3) coordinate education on reporting suicide; and 4) establish and
maintain a permanent website that is available for all to visit at www.scc@ov.or@/spac.
Media Education and Engagement
By and large, the bulk of the work will relate to
educating the media and formal public
communication.
Research has shown that graphic,
sensationalized or romanticized descriptions of
suicide deaths in the news and social media and
the internet can contribute to suicide contagion,
sometimes referred to as "copycat" suicides,
"media-related suicide contagion," or "cluster
suicides," and other similar terms. In addition to
the danger of this phenomenon, media reports
on suicide can also be a source of
misinformation, for example, when suicide is
attributed to a single event, such as the loss of a
job or a relationship with no mention of
underlying factors such as the individual's
depression, substance abuse, or lack of access to
treatment for these conditions.
In contrast, responsible coverage of suicide can
educate wide audiences about the likely causes
of suicide, its warning signs, trends in suicide
rates, recent treatment advances and other ways
suicide can be prevented. Stories about well-known figures who have successfully sought
treatment for depression, alcoholism and other conditions that convey suicide risk can also be a
powerful impetus for readers to address such issues in their own lives.
Additional Strategies: Policy and Governance Advocacy
There is considerable infrastructure to be created for a prevention campaign to function
effectively and for effective monitoring and evaluation activities to proceed. However, the
development of this countywide infrastructure depends upon advocacy for supportive, enabling
policies and legislation.
Packet Pg. 559
Individuals function within a larger system beyond their families. For example, children spend
their days in schools, child care centers, youth centers, juvenile justice system, or alone. Adults
spend the majority of their days at work, in higher education or vocational training schools, in
the criminal justice system or alone. Without the support and active participation of these
larger systems in adopting simple measures, any prevention campaign would be seriously
hampered. Simple measures such as creating, adopting, and implementing policies regarding
the awareness and identification of individuals in emotional crisis or dealing with a mental
illness is a simple, effective step.
Again, the planning committee recognized that this will be an ongoing activity and will require
additional investments of time and resources for successful implementation.
Additional Strategies: Data Monitoring and Evaluation
As the SPAC reviewed national information about suicide and suicide risk, it became clear that
nowhere in our nation is detailed information available at the local level in a way that provides
policy makers and stakeholders with the amount of information needed to accurately describe
the profile of who is at risk of suicide. Further, there is no clear way in which those suicide
prevention efforts that
currently are in place, or may
be implemented with
approval of this plan, can be
evaluated for their
effectiveness without a
clearly defined, measureable
monitoring and evaluation
process in place.
The data monitoring strategy
will include overseeing the
coordination, collection, and
reporting of useful data in
close partnership with the
Medical Examiner and Coroner's Office. With the large, dissimilar number of agencies that are
mandated to report self injury and "proven" suicides, there is much work to be done to agree on
basic data needed; establish or adapt existing processes for reporting, collecting, and analyzing
that data in a timely manner; and monitor data to evaluate the success of these efforts.
Local Suicide Resources: A Range of Services
As a part of the process of determining local priorities, the SPAC assessed available local
resources. Several Santa Clara County Mental Health Department programs were identified as
contributing to the reduction of suicides. Moreover, these programs already are consistent
with the recommendations of the California Strategic Plan on Suicide Prevention. A full listing
of agencies, programs and services that interact with individuals who die by suicide are listed in
Attachment 2 in the Appendix. Some of the programs are specific to suicide prevention, such
as the County-operated Suicide and Crisis Services (SACS), a 24-hour hotline staffed by a
combination of paid and unpaid volunteers that respond to 35,000 calls per year from the
community. As is common with many crisis hotlines, a small percentage of the calls are for
immediate suicide interventions. The bulk of calls are for non-suicidal crisis help and
information, which helps to prevent individuals from reaching the point of considering suicide.
SACS also provides support groups and other support programs in collaboration with
community-based programs operated by Kara and the Bill Wilson Center's Centre for Living
with Dying. The EMQ Crisis Team provides in the field crisis intervention services to children
and adolescents; and the County's Emergency Psychiatric Services (EPS) provides 24-hour
emergency intervention to individuals who require immediate psychiatric treatment, often
meeting involuntary treatment criteria as "danger to self."
Pending and Future Additional Prevention Resources
In addition to these existing programs, the County's efforts to reduce suicides will be further
enhanced when the Mental Health Services Oversight and Accountability Commission
(MHSOAC) facilitates the implementation of the Statewide Suicide Prevention Program. The
County will benefit though previously approved assignment of local MHSA funds to this
statewide effort. Approximately 913.7 million in local MHSA funds have been assigned for
several statewide projects, including Suicide Prevention, Stigma and Discrimination Reduction,
and School Mental Health Initiatives.
In addition, the Mental Health Department is currently implementing several projects approved
by the MHSOAC in our local Prevention and Early Intervention Plan. Those projects include:
s "Early Onset of Mental Illness" - a prevention and early intervention program focusing
on the needs of transition-age youth who may be experiencing at risk mental states
(ARMS) or the onset of serious psychiatric illness with psychosis (e.g., schizophrenia).
One study found that 15% of participants in an early psychosis program attempted
suicide before beginning treatment.
a Primary Care Behavioral Health Integration - A project to integrate early intervention
b ehavioral health services within primary care clinics to meet the emerging needs of
adults and older adults. The project will use the Improving Mood-Promoting Access in
Collaborative Treatment (IMPACT) model.
s Outreach and Engagement - a grassroots "gatekeeper" and mental health literacy
program that trains key community members to be more aware of and responsive to
early signs and symptoms of emotional distress.
s Community Investment Initiative - Programs that enable underserved communities to
develop and implement campaigns to reduce stigma and discrimination concerning
mental illnesses within their communities so that individuals are more willing to
promptly seek help.
Moreover, these are only a few of the programs that will be included in the County's overall
Prevention and Early Intervention (PEI) Plan. Through the PEI Plan, the Mental Health
Department intends to bring mental health awareness into the lives of all members of the
community and move the mental health system toward a "help-first" approach. The County's
plan also will be coordinated with several state-administered, statewide PEI projects, including
Suicide Prevention, Student Mental Health Initiative, Stigma and Discrimination Reduction, and
Ethnically Specific Interventions. Together, statewide projects and local county PEI plans will
create a system of prevention and early intervention services throughout the state.
What Experts Recommend
"Prevention efforts should ultimately reduce risk factors and promote protective factors. In
addition, prevention should address all levels that influence suicide: individual, relationship,
community, and society. Effective prevention strategies are necessary to promote awareness
about suicide and to foster a commitment to social change."99 Santa Clara County's Suicide
Prevention Plan, when taken as a coordinated and interwoven set of strategies and efforts, will
act in concert to prevent suicide. Individuals as well as organizations will have a role to play to
contribute to the success of this effort. Our entire community as a whole has an active
choice-to value each life and recognize that even one life lost to suicide was a preventable
death.
Best Practices-Evolving Knowledge
The Suicide Prevention Resource Center (SPRC), in collaboration with the American Foundation
for Suicide Prevention (AFSP), maintains a Best Practices Registry (BPR). This project is funded
by the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of
the BPR is to identify, review, and disseminate information about best practices that address
specific objectives of the National Strategy for Suicide Prevention. The BPR has three sections:
Section l: Evidence-Based Programs (including la: SAMHSA's National Registry of Evidence-
Based Programs and Practices; and lb: SPRC/AFSP Evidence-Based Practices); Section II: Expert
and Consensus Statements; and Section Ill: Adherence to Standards.
Attachment 3 in the Appendix outlines ten prevention programs that address suicide and are
currently listed on the NREPP registry: National Strategy for Suicide Prevention Ten Prevention
Programs. In addition to the ten listed programs, the American Foundation for Suicide
Prevention: Suicide Prevention Resource Center's Evidence-Based Practices list contains an
additional two.
As we make gains in breaking the taboo of suicide, we have an opportunity to learn more and
contribute to the nascent and ever changing field of suicide prevention best practices.
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V. What We Recommend:
Five Overarching and Interconnected Pieverd;uii Slrategies
The SPAC has identified five overarching recommendations, referred to as strategies that
comprise the core of the Suicide Prevention Plan. These recommendations are born out of the
values of the committee, the data and information reviewed and presented in this report, the
personal experiences shared, and the feedback from the public forum. They are consistent with
the American Foundation for Suicide Prevention Best Practices Registry suggestion, "In general,
practitioners will achieve greater results by creating comprehensive approaches involving
multiple layers of coordinated components."
Strategy One - Implement and coordinate suicide prevention and
intervention programs and services for targeted high risk
populations
Strategy Two - Implement a community education and information
campaign to increase public awareness of suicide and suicide
prevention
Strategy Three - Develop local communication"best practices" to improve
medfia coverage and public dialogue related to suicide
Strategy Four - Implement policy and governance advocacy to promote
systems change in suicide awareness and prevention
Strategy Five - Establish a robust data collection and monitoring system to
increase the scope and availability of suicide-related data and
to evaluate suicide prevention efforts
While the basis for each strategy is summarized in the previous assessment section of this
report, specific preliminary objectives for each strategy are outlined below. It is expected that
once the broad strategies recommended in this plan are approved, an implementation plan wilt
be written for each strategy. The implementation plan will further refine the objectives of each
strategy as well as the steps to implementation and the budget requirements.
To ensure the successful project coordination and management, the Mental Health Department
intends to hire a full-time Suicide Prevention Coordinator and Liaison to State Office of Suicide
Prevention. That selection process has begun, and it is expected that someone will be hired for
that role by August or September 2010.
Strategy One - Implement Suicide Interventioii Pioyiumh und Services
for Targeted High Risk Populations
Desired Outcomes
1. Decrease in the number of completed suicide acts.
2. Decrease in the number of attempted suicides.
3. Increase in the availability of culturally and linguistically appropriate and affordable
intervention services in a variety of venues.
4. Improved and earlier identification and engagement of people dealing with mental
illness.
5. Improvement in referral relationships to access appropriate care.
6. Increase in help-seeking behavior from individuals with mental illness and from
those who are connected to individuals with mental illness.
7. Increase in support services to the fami!y members and social network of individuals
with mental health issues.
8. Improvement in quality of life for individuals and their loved ones who are dealing
with mental illness.
9. Increase in diversity of services and programs that are tailored to high risk
populations-youth, elders, internet, face-to-face.
Target Populations
1. Populations with highest risk of engaging in suicidal behavior (identified in section V.
Review and Summary of Local Needs)
2. Individuals supporting persons at risk of suicide, such as significant others, family
members, caregivers, professionals, clergy/faith leaders
3. Key service providers, such as mental health clinicians and primary care physicians,
clergy, faith leaders, law enforcement
4. Community members
CurrentActivities and Recent Gains
Independent of this committee's activities, other agencies are working to reduce and eliminate
suicide. Discussed in more detail in Appendix 2, the following are summaries of ongoing
intervention activities occurring in our county and possible next steps:
o
s Suicide and Crisis Services (SACS). This County program provides residents with access
to a 24-hour telephone hotline. Operated primarily by 100 volunteers and with less
than S190,000 in annual funding, the program fields over 35,000 calls annually from
suicidal clients, concerned family members and other residents in crisis. Approximately
ten percent of calls are from individuals with suicide ideation. Recommendation:
Evaluate if the community would be better served if SACS attained national Lifeline
accreditation or whether to simply unify the three distinct phone numbers into one and
expand the current program. [SACS consolidated its numbers to 1-855-278-4204. Feb. 2011]
Strategy One - Continued
Survivors of Suicide Group and grief /loss support programs operated by Kara and the
Bill Wilson Center's Centre for Living with Dying. Recommendation: Identify how more
groups can be established throughout the county and increase efforts to recruit
moderators to provide this service.
s SACS staff members provide training to various community organizations on suicide
assessments and crisis intervention. Due to repeated budgetary restrictions, available
staff to provide such valuable training is very limited. Recommendation: Seek
alternative means and additional funding sources to be able to double or triple current
trainings.
ffl County Mental Health Services. This County program provides an array of mental health
services to primarily Medi-Cal beneficiaries and those who are uninsured. Approximately
22,000 children, adolescents, young adults, adults and seniors receive services annually
through a network of County-operated and contracted programs.loo Services range from
outreach, peer advocacy, and case management to clinical care and support in a variety of
community, outpatient, residential and day programs.
s Community-based organizations (CBOs). CBOs account for approximately half of the public
mental health system's capacity, and they are a key component of the entire public safety
net. These CBOs address county residents' behavioral health needs, including mental
health concerns that involve the risk of suicide. The CBOs also leverage other funding
sources and operate a variety of programs that address behavioral health needs that are
not funded by the County Mental Health Department, such as the Status Offender Services
network.
a EMQ's Families First Child and Adolescent Mobile Crisis Program. This program responds to
the serious emotional trauma of minors, offering services in the home, at school and in the
community. The EMQ Team responds 24/7 and often facilitates hospitalization and/or crisis
intervention services to suicidal children and youth with other community agencies for long-
term care and assistance. There is only one team that covers the entire county.
Recommendation: 1) Investigate how this model could be expanded or replicated by other
agencies. 2) Identify how this model could be expanded to provide similar services to
adults.
a Emergency Psychiatric Services (EPS). Operated at Valley Medical Center, EPS is the
single psychiatric emergency receiving center in the county. The program is key in
responding to acute mental health crises that often involve risk of suicide. The 24/7 EPS
program provides intervention services to individuals experiencing acute psychiatric
episodes and who may be a danger to themselves or others. Annually, approximately
7,500 individuals arrive at EPS on "5150 holds," brought by law enforcement officers
and others. The large majority of involuntary holds specify the "danger to self" criteria.
Strategy One - Continued
Mental Health Urgent Care (MHUC). This voluntary, unlocked, County-run program also
provides residents with crisis intervention services. Services at MHUC, which are available
to walk-ins, are provided daily from 8 am to 10 pm. Clients, family members, law-
enforcement agencies and other first responders are encouraged to use MHUC to meet the
needs of individuals experiencing severe emotional or psychological distress, including
thoughts of self-harm. Recommendation: Promote this service more broadly to increase
utilization.
s Police Crisis Intervention Training (CIT). In partnership with law enforcement agencies, the
MHD is continuing to enhance law enforcement officers" abilities to manage crises involving
mentally ill residents. In addition to reducing the need for using deadly force, this program
can save lives by giving officers tools they can use when encountering individuals who
intend to lose their lives by intentionally threatening police officers (i.e., suicide by police).
Recommendation: 1) provide CIT training for cadets, and 2) collaborate with law
enforcement to ensure that more officers receive Crisis Intervention Training (CIT).
s Golden Gateway. In addition to providing intensive case management and therapy to
severely mentally ill older adults, this program conducts extensive outreach to and
mobile assessments of homebound or shut-in seniors who would benefit from mental
health services. Golden Gateway's services are important for preventing suicides in
California. Adults aged 75 and over have the highest rates of suicide (California Strategic
Plan on Suicide Prevention, June 2008).
ffl Self-Help Centers. These County programs offer drop-in, self-help and peer support for
mental health consumers. Three programs provided in North, Central and South County
locations offer the opportunity for consumers to find support and compassion within a
supportive peer-run setting.
ffl Ethnic and Cultural Community Advisory Committees (ECCACs). Based on a similar
philosophy to the self-help centers, the ECCACs are family and consumer support teams
from eight ethnic and cultural communities.
o
a Gatekeeper Training. This will provide training to individuals in the community to increase
the community's ability to refer friends and loved ones to appropriate resources at an
earlier point in an individual's emotional crisis.
a Integrating Behavioral Health Services in Primary Care. The Mental Health Department wil[
announce a Request for Proposal to support integrating behavioral health services in
community-based, primary care settings by January 2011. Service delivery should begin by
July 2012 and is intended to impact 4,200 individuals a year.
Strategy One - Continued
a Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI) Project 3-
Prevention and Early Intervention for Early Onset Psychosis (in Youth and Young Adults 16-
25). This Request for Proposal was announced June 7, 2010. Service delivery of early
identification and treatment services should begin in October 2010. It is intended to
provide countywide intervention and treatment services to 30 new clients a year.
RecommendedActions
Convene an implementation committee to accomplish the following:
Conduct further research on specific practices for possible implementation and their costs
Provide detailed analysis of available resources and service gaps
Convene and implement a subcommittee for each age group
Finalize recommended strategies
Develop process and performance metrics for recommended/adopted strategies
Prioritize specific strategies in regard to available funding and leveraging opportunities
Identify strategies to procure and implement funding for selected strategies
Prepare strategic implementation plan to be informed by public process
Packet Pg. 570
Strategy Two - Implement a Community Education and Information
Campaign to Increase PublicAwareness ofSuicide andSuicide
Prevention
Desired Outcomes
The Community Education and Jnformation Campaign will focus on achieving the following
outcomes:
1. Increased awareness of mental health issues, including depression and suicide
2. Increased public awareness of suicide
3. Improved identification of people who are feeling suicidal
4. Improved public knowledge of how to respond to a person who is feeling suicidal
5. Increased awareness of how to engage in and access support services, grief
counseling services, and postvention services
6. Decreased judgment or blame associated with suicidal thoughts and feelings
Target Populations
This strategy involves a community-wide suicide prevention and awareness campaign to reach:
1. General public of all ages
;. Medical providers and support staff
:i. Mental health clinicians and support staff
zi. Clergy and faith leaders
s. Caregivers
6. In-home support workers and others who work with seniors and the disabled
7. Family members
Current Activities and Recent Gains
s Assigned a temporary suicide prevention project coordinator and liaison to California Office
of Suicide Prevention. Recommendation: Mental Health Department hires a suicide
prevention project coordinator/liaison to the California Office of Suicide Prevention.
a Improved communications with the Santa Clara County Medical Examiner-Coroner's Office
with the Survivor's of Suicide Program operated by the County, to ensure surviving families
are better informed of available grief support services.
a Instituted a dedicated website to suicide prevention on the Mental Health Department's
website: www.sccgov.org/spac with a focus on informing the public of '3his effort and
improving awareness. Recommendation: Evaluate and determine the audience for the
website, the main objectives for the website going forward, and the best manner to
promote this website throughout the county.
o
Packet Pg. 571
Strategy Two - Continued
' Promoted an existing youth-focused (16-24 years) suicide prevention website
www.reachout.com. Following the success of its Australian website, which proved
instrumental in reducing the rate of youth suicide in Australia by more than half,lol the
Inspire USA Foundation launched its American website from its San Francisco-based offices
in March 2010. Reachout.com is an interactive website for young people that deals with
coping with mental health problems; dealing with suicide and self-harm; drugs, alcohol and
tobacco; family relationships; friend and peer relationships; becoming independent; loss
and grief; maintaining good health; romance, sexuality and pregnancy; school pressures;
and violence. The Executive Director was a guest speaker at one of the SPAC's meetings
and is eager to partner more in our county's suicide prevention efforts. Recommendation:
Promote this website broadly.
a Ca!train, an active partner in this effort, has agreed to make available advertising space on
their trains, stations and buses for the specific use of this public education and awareness
campaign. Recommendation: Work in close partnership with local transportation agencies,
including \/TA, to identify available means for communicating outreach message to
ridership. Also, forge a tri-county or more partnership to share the cost of the outreach
campaign, beginning with San Mateo and San Francisco Counties.
a Our county's school districts and County Office of Education have been actively involved in
the effort to reduce youth suicide and raise awareness among their staff on how to
recognize students in emotional distress or crisis and how to intervene and provide support.
Recommendation: 1) Support schools in engaging their communities in dialogues about
mental health and suicide prevention. 2) Track which school districts are adopting suicide
prevention policies.
a Enlisted clergy, other faith leaders and lay leaders in the faith community to join in this
effort. One of the committee's members, Bernie (Deacon) Nojadera represented Interfaith
Connections and related the committee's goals, learning and activities to members of that
group. More concentrated work can be done. Recommendation: Collaborate with the faith
community to promote mental health awareness and suicide prevention in their ministry
and outreach.
a Conducted a well attended Suicide Prevention Public Forum to obtain public comments and
suggestions about suicide prevention and how to develop greater community awareness.
RecommendedActions
a Utilize multi-media tools in health care settings to promote awareness of mental health
issues and suicide. Target Implementation Date: FY 2012 with award and implementation
of Prevention and Early Intervention projects.
a Support efforts such as Onyourmind.net, a youth-oriented website that provides a safe and
anonymous place for teens to get information and support from other teens. Youth are
able to talk about anything on their minds, including relationships, school, depression,
:1. ,
Strategy Two - Continued
StreSS, suicide, friends, parents, cutting, identity, and health. They also can submit a
question to be answered on the Q&A page or connect to resources for additional
information and support.
s Enlist clergy, other faith leaders and lay leaders in the faith community to join in this
community education and awareness effort. The elderly often have more regular contact
with clergy and church members than with any other individuals or organizations. Seniors
have the highest church attendance rates across all age groups, and clergy often are the
first professional groups to which people turn when they have personal problems.lo2
Moreover, clergy and other faith leaders are among the few whose responsibilities regularly
take them into homes and care facilities. Target Implementation Date: September 2009,
after the Board of Supervisors has approved the Plan.
s Buildoncurrent,successfulMHSA-supportedeffortstocoalescetheclergyandotherfaith
leaders around efforts to better recognize and respond to emerging mental health needs
and to recognize and combat signs of elder abuse, either caused by self-neglect or
perpetuated by others. All of these endeavors recognize that Santa Clara County is one of
eleven counties in California predicted to experience the greatest population growth among
its seniors.lo3 Target Implementation Date: September 2009, after the Board of Supervisors
has approved plan.
ii Enlist suicide attempt survivors, suicide survivors (individuals who have lost a loved one to
suicide), and suicide prevention collaborative members to conduct a "Listening Campaign"
at multiple locations throughout the county. This follows the model implemented by the
u.s. Army to solicit feedback on the emotional pulse of their communities. Additionally,
this activity encourages awareness and discussion of mental health issues, suicide
preventionandavailableresources. Recommendation:KickoffthiseffortaftertheSuicide
Prevention Coordinator has been hired by the Mental Health Department.
a GatekeeperTraining. Therearemanymodelsavailable. Recommendation: Identifyand
adopt the version or versions that would be most effective for our county to serve dual
functions: 1) increase awareness and identification of individuals in need or emotional
duress; and 2) improve community involvement in seeking support for individuals in
emotional crisis or need.
o
s Recommendation: Create a Communications Plan Work Group, discussed in Strategy 3, to
play an advisory role in the following Community Education and Information activities:
* Create,replicateandimplementavarietyoftoolsandtechniquestobetter
inform people about suicide, suicide prevention, and mental health awareness.
* Explore feasibility of creating a new PSA campaign or utilize and promote
existing PSAs. For example, the AdCouncil has a current teen suicide prevention
II
Strategy Two - Continued
campaign sponsored by the u.s. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration.
* Ensure the Community Education and Information Campaign will include multi-
media outlets as well as evaluating if new spots should be created or if we
should promote and utilize existing campaigns. For example, "We've Been
There" is an existing television spot with a partner "We've Been There" radio
spot. "Angry Hurt Helped" and "Hopeless Lost Inspired" are some campaigns
developed for print media. Social networking sites, as well as outdoor and
interactive elements will need additional messaging created or existing
messaging identified to be considered for possible use.
* Ensure leveraging of existing and available media productions that promote
awareness. For example: More Than Sad Films, produced by the American
Foundation for Suicide Prevention (AFSP) in partnership with the New York State
Office of Mental Health. This 25-minute film and manual is part of an
educational program to help teachers and other school personnel learn more
about teen suicide and how they can play a role in its prevention.
* Enlist a collaborative effort with our neighboring counties, San Mateo and San
Francisco, to participate and perhaps leverage resources for a Silicon Valley-wide
multi-media campaign.
ffl Develop concise, clear messaging vehicles to quickly convey information.
ffl Give a voice to suicide attempt survivors and individuals who have lost a loved one to
suicide (suicide survivors) so they can become a positive force in the community and
prevent future suicides.
s Educate systems that involve large populations on suicide prevention and response.
s Encourage and coordinate opportunities for groups to share cultural and familial
perspectives on death and dying.
Strategy Three - Develop Local Communication "Best Practices" to
Improve Media Coverage and Pub(ic Diagogue Related to Suicide
Desired Outcomes
1. Creation of a coordinated communication strategy that
* Ensures the development of a clear, concise, paradigm-shifting message
for all outreach efforts;
* Ensures that the guidelines for responsible communication on issues
pertaining to suicide are adhered to by media and agencies; and
@ Ensures consistency in public messaging.
2. Educate various sectors of our economy: for-profit, government, non-profit.
3. Increase knowledge in local media on the importance of responsible reporting about
suicide as measured by adherence to Safe Reporting on Suicide guidelines (see page
56).
4. Obtain agreement and follow-through among key media outlets (traditional and
non-traditional) to coordinate public news releases strategically to address periods
when suicide risk is higher and to respond appropriately to suicide deaths, clusters,
and suicide-homicide deaths.
s. Obtain agreement and follow-through among key media outlets (traditional and
non-traditional) to ensure the utilization of resource directories on local suicide
prevention and crisis services in multiple languages.
o
6. Obtain agreement and follow-through among key media outlets to ensure all
materials are linguistically and culturally appropriate for Santa Clara County's
residents.
7. Maintain a dedicated suicide prevention website and clarification of its target
audience and purpose.
Target Populations
1. Local media outlets-traditional and non-traditional
2. Public Information Officers (PIOs) in government and business
3. Human resources departments, employee assistance services, unemployment
offices, and Social Security Offices
CurrentActivities and Recent Gains
Fortunately, there are abundant, credible sources of information about concrete ways to
improve the media coverage of suicides and reduce the rate of reporting activities precipitating
additional suicides or attempts. The result of a collaborative effort WaS the development and
Strategy Three - Continued
release of a consensus document, Reporting on Suicide: Recommendations for the Medial04.
s National advocate for suicide prevention and member of the SPAC, Mary Ojakian, along
with SPAC member Mark Simon, participated in Project Safety Net and helped to organize a
round table discussion among several local publishers on the importance of adopting the
guidelines on safe reporting on suicide.
s A website dedicated to suicide prevention was established on the Mental Health
Department's website, www.scc@ov.org/spac, listing resources and describing activities of
the Suicide Prevention Advisory Committee. Recommendation: A Suicide Prevention
Project Coordinator should ensure that the website is in alignment with messaging defined
by the Work Group and in alignment with best practices to the fullest extent possible.
ii Assigned project coordination responsibilities to the liaison to the California Department of
Mental Health's Office of Suicide Prevention.
RetumincndcdActions
The Suicide Prevention Advisory Committee (SPAC) recommends the following activities
to ensure an effective Communications Plan:
1. Convene a Communications Plan Committee, chartered to:
Develop a Communications Plan appropriate for the diverse residents of Santa
Clara County.
a Define one to three clear, concise, paradigm-shifting priority messages (e.g.,
MADD's "Friends don't let friends drive drunk").
ffl Using local community input, tailor the above paradigm-shifting messages for
different targeted populations, i.e., language, age, etc.
a Educate media and local reporters about safer protocols on reporting suicide
attempts and deaths. The SPAC recommends the utilization of the "Safe Reporting
on Suicide Guidelines," prepared by the Suicide Prevention Resource Center.
These guidelines are recommended for promotion and utilization in Santa Clara
County. Dissemination of these guidelines should be one aspect of this strategy.
Engaging in discussions with each of the media outlets should be the emphasis.
a Consider and review the potential of existing efforts to raise awareness for
possible inclusion in this strategy. Some examples for consideration include a
training workshop targeting reporters and media personnel offered by the
American Foundation for Suicide Prevention (AFSP) and the Substance Abuse
Mental Health Services Administration's (SAMHSA) "Picture This: Depression and
Suicide Prevention," a publication targeting media personnel.
a Consider fostering a broad coalition including neighboring counties that all share
the Silicon Valley's media communications, to include San Mateo and San
Francisco Counties, to leverage funding and resources.
Packet Pg 576
Strategy Three - Continued
a Work with social networking companies.
a Continue work on development and implementation of PSAs, news releases,
web-based information, and other media/materials.
Strategy Four - Implement Policy and Governance Advocacy to
Promote Systems Change in Suicide Awareness and Prevention
Desired Outcomes
While specific measurable outcomes need to be developed for this strategy, in general terms,
goals of this strategy are to:
1. Increase public awareness of suicide as a public health problem within an
organization by promoting adoption of policies and programs that either work to
prevent suicide or respond to emotional crises.
2. Promote local, state, and federal policies and programs that prevent suicide.
3. Disseminate information to individuals in the community regarding the Santa Clara
County Suicide Prevention Plan and its recommended activities.
4. Build partnerships with other local suicide prevention and mental health agencies,
governments, media, and other organizations with a stake in public health.
s. Help remove the stigma associated with suicide by bringing the subject out in the
open and discussing what can be done to prevent it.
6. Recruit individuals and organizations to advocate for policy change and/or adoption
in their workplace or community site.
";i. Change laws-see RecommendedActions below.
s. Advocate for prevention funding.
Target Populations
The committee's recommended strategies in this category include advocacy on behalf of:
g Partnerships between primary care and mental health professionals;
a Partnerships with support organizations and service providers (e.g., churches, employee
assistance programs, schools, National Alliance on Mental Illness, etc.) to raise
awareness and create a welcoming environment for those at risk of suicide;
ffl Strong networks of support organizations and service groups (e.g., a network of youth-
supporting organizations and service groups);
z Active participation across sectors, industries, and groups in implementing strategies
(e.g., education, healthcare, non-profit, for-profit, government);
a Legislative or policy changes in government and institutions, with a goal of convincing as
many systems as possible to play key roles in suicide prevention;
s Broad adoption of policies mandating cultural and linguistic competency;
a Standardization of reporting requirements across sectors and agencies; and
a Possible certification of a countywide hotline with National Suicide Prevention Center's
Lifeline.
i! ,
[H
Strategy Four- Continued
Current Activities and Recent Gains
s Palo Alto Unified School District Board of Education adopted a policy for suicide prevention
in their school district at their meeting June 1, 2010, and Los Gatos Union High School
District is working on a similar policy.
a Palo Alto Unified School District has shared their policy and Articles of Regulations
implementation guidelines. All districts have been requested to create a comparable policy.
s Partnered with the County Medical Examiner-Coroner's Office to improve data collection
for future psychological profiling activities of those identified as dead by suicide.
s County Medical Examiner-Coroner's Office provided the first-ever comprehensive
investigative reports for all suicides that occurred in 2009 to be able to begin to analyze and
possibly use in future psychological profiling efforts.
s County Medical Examiner-Coroner's Office is considering the adoption of a new policy that
they annually prepare investigative reports for all suicides that occurred in the previous
year for subsequent analysis of the data.
s Revamped training for involuntary suicide prevention holds-5150/ 5250.
ii In partnership with law enforcement agencies, the Mental Health Department is continuing
to enhance law enforcement officers' abilities to manage crises involving mentaly ill
residents through Police Crisis Intervention Training (CIT). In addition to reducing the need
for using deadly force, this 40-hour program can save lives by giving officers tools they can
use when encountering individuals who intend to lose their lives by intentionally
threatening police officers (i.e., suicide by police). Recommendation: 1) Advocate for more
required mental health training for cadets, and 2) advocate for law enforcement agencies to
require that more officers receive Crisis Intervention Training (CIT).
s Our county's school districts have been actively involved in the effort to reduce youth
suicide and to raise awareness among their staff on how to recognize students in emotional
distress or crisis and how to intervene and provide support. Recommendation: Advocate
and monitor adoption until all school districts adopt and implement a policy.
gPEl Project 5 - Suicide Prevention. The Interim Suicide Prevention Oversight Committee will
write PEI Project 5 - Suicide Prevention Proposal for submission to the Oversight and
Administration Committee (OAC) for approval. This proposal will include funding for a
Suicide Prevention Coordinator. Anticipated submission date for the new project is August
to September 2010. Approval for the new project is expected by July 2011.
a The Mental Health Department will request joining the California Mental Health Services
Authority (CalMHSA) in August 2010, with acceptance anticipated for October 2010, at
which time the Mental Health Department will be able to represent Santa Clara County in
the California Mental Health Services Act discussions and deliberations concerning the:
* Student Mental Health Initiative
* State suicide prevention efforts and programming, and
* Ethnic specific programs.
Packet Pg 579
Strategy Four- Continued
Recommended Actions
We will identify and work with local organizations, including schools and school districts, to
support suicide prevention efforts. This will be part of an ongoing effort to identify, share and
leverage resources, to provide other forms of assistance as feasible and desirable, and to move
toward the objective of comprehensive adoption and implementation of effective suicide
prevention measures in all key venues.
The American Foundation for Suicide Prevention (AFSP) suggests several tools for learning more
about effective advocacy. The SPAC recommends that these tools be considered when
detailing the specific activities of this strategy. The references include:
a National Mental Health Association's Advocacy Primer
a Grassroots Tool Kit: A manual on event planning, coalition building, and grassroots
advocacy from the Leadership Conference on Civil Rights
a Advocate's Guide to Grassroots Organizing During a Congressional Recess from the
Leadership Conference on Civil rights, and
a Speak, Out! A Guide to Advocacy regarding Mental Health Policy from the Mental
Health Association of Westchester County.
Some specific actions suggested by the AFSP in the area of advocacy include, but are not limited
to, the following:
1. Strengthening legislation on veteran and military suicide prevention to promote
longitudinal research on the rates and develop anti-stigma campaigns and
continue to expand suicide prevention programs to assist members, returning
veterans and their family members.
2. Adoption of legislation and other policy directives to encourage the National
Institutes of Health Agencies to invest more substantially in research related to
suicide, suicide prevention, and survivors of suicide loss or suicide attempts.
3. Appropriations at the maximum attainable level for the National Violent Death
Reporting System.
4. Implementation of Mental Health Parity and Health Insurance Reform.
5. ReauthorizationofandappropriationsfortheSubstanceAbuseandMental
Health Services Administration (SAMHSA).
6. Adoption of legislation to allow the Golden Gate Bridge Authority (and other
local jurisdictions) to use federal funds for bridge suicide prevention barriers.
7. Adoption of legislation that aims to reduce bullying and cyber-bullying.
8. Adoption of legislation to establish Depression Centers of Excellence.
Attachment: Santa Clara County Suicide Prbv'ention Strategic Plan (Suicide Prevention Policy)
[I
Strategy Five - Establish a Robust Data Collection and Monitoring
System to Increase the Scope andAvailability ofSuicide-Related Data
and to Evaluate Suicide Prevention Efforts
This strategy develops and sustains processes for collecting and analyzing state and local data
that will help establish local program priorities and evaluate the impact of suicide prevention
strategies.
Desired Outcomes
Proving that this plan is making a difference by reducing the number of deaths by suicide can
only be accomplished by collecting data and monitoring the activities of the plan and its
outcomes. In order to do this the following goals must be met:
1. Expand reporting on suicide attempts and deaths;
2. Increase accuracy in reporting of data related to suicide and prevention
activities;
3. Increase the convergence of data reported by various entities;
4. Increase availability of comprehensive data on suicide-related activities in Santa
Clara County; and
5. Establish and define a centralized monitoring body of suicide prevention
activities and outcomes.
Target Population
1. General public
2. Policy makers and funding entities
3. Local public health monitoring system
4. Implementation entities
Current Activities and Recent Gains
ffl Partnered with County Medical Examiner-Coroner's Office to improve data collection for
future psychological profiling activities of those identified as dead by suicide.
s County Medical Examiner-Coroner's Office provides to the committee a compilation of the
routine investigation reports for all reported suicide deaths on a yearly basis, beginning with
2009 deaths.
ii Collected and conducted a preliminary review of suicide data for Santa Clara County
including by zip code, city, and a variety of social factors.
s Conducted preliminary needs assessment of high risk population groups.
Strategy Five - Continued
Reuhm}}CikdCd ACtgOnS
Local efforts, as recommended by the SPAC, will be defined more specifically and completed
during the implementation phase. Theyinclude:
1. ldentifyaMonitoringTeamto
a. Oversee plan implementation,
b. Identify resources and funds,
c. Produce an implementation schedule,
d. Select and begin meetings of a Suicide Prevention Oversight Committee
(SPOC),
e. Devise plan for continuous data collection and analysis,
f. Develop and report standards for monitoring and measuring plan outcomes,
and
g. Elicit public input on strategies and funding priorities;
2. Determine specifically what additional data are needed to accurately monitor
the number of lives lost to suicide;
3. Define baselines for strategies in existence at that time;
4. Conduct a review of all suicide prevention resources in County;
5. Define or refine p(anning and process metrics to track prevention and
intervention strategies;
6. Review and interpret data on lives lost to suicide;
o
7. Work for the creation of a Santa Clara County Suicide Death Review Committee;
and
8. Monitor the Plan's implementation to ensure that efforts continue across
various systems as part of a countywide approach to reduce suicide.
The committee recommends achieving the desired outcomes by establishing a monitoring
system as described by "National Strategy for Suicide Prevention, Goals and Objectives for
Action," an outline adopted by the u.s. Department of Health and Human Services, the
Substance Abuse and Mental Health Services Administration and the National Mental Health
Information Center, which includes the following:
s Track trends in rates,
s Identify new problems or additional data required,
s Provide evidence to support activities and initiatives,
a Identify risk and protective factors,
ffl Target high risk populations for interventions, and
a Assess the impact of prevention efforts.
o
Packet Pg. 583
Strategy Five - Continued
Additionally, the committee recommends:
Establishing a Death Review Panel and process to review reports of all deaths by suicide,
and possibly suspected suicide in order to create psychological profiles of those at risk.
ffl Create an annual report based on psychological profile findings to contribute to the
knowledge of suicide in Santa Clara County.
a Learn from past suicides and suicide attempts to prevent similar situations in the future.
s Conduct a comprehensive assessment of mental health services and standards in the
county.
g Identify what additional data is required for our county's suicide prevention efforts.
s Identify leading causes of suicide in Santa Clara County to assist in identifying priorities
for means restriction, as appropriate.
s Develop and maintain a current database of academic articles, data, and other resources
on suicide.
s Monitor high-traffic, youth-oriented websites to assess suicide-related content and take
action where needed. (Examples of online sites include: YouTube, Facebook, and Twitter.)
s Inventory existing social and medical service centers, such as hospitals and medical
clinics, to determine gaps and best practices in the mental health system.
s Monitor outreach activities offering support for previous suicide attempters.
s Conduct a comprehensive assessment and determine methods to reach and provide for
those at-risk of suicide.
Potential sources for data
s Nationally, suicide surveillance data come from death certificates. This vital statistics
information is available from the National Center for Health Statistics, Centers for
Disease Control and Prevention. Medical examiner databases also provide some
information related to suicide. The information on rates available from vital statistics
databases obviously does not include those deaths misclassified as homicides or
accidents, and an unknown number of others misclassified as natural causes but which
may actually be suicides. Information available from death certificates is limited and is
not always complete. Prevention efforts would be enhanced by more comprehensive
information. However, such information is not now systematically collected.
s Data on suicide attempts must come from sources designed for other purposes, such as
trauma registries and uniform hospital discharge data sets. Trauma registries provide
detailed information about the nature and severity of an injury, the treatment provided,
and the status of the patient on discharge from the hospital. However, most trauma
registries include only "major" trauma cases, those that require at least a three-day
hospital stay. Moreover, many suicide attempts do not lead to traumatic injuries (e.g.,
Strategy Five - Continued
overdoses of medicines). Thus, trauma registries have only limited information on
suicide attempts.
u A uniform hospital discharge data set is another potential source of information on
suicide attempts. As suggested by its name, a hospital discharge data set provides
information only about those suicide attempts that resulted in hospital treatment. Not
all states require either trauma registries or uniform hospital discharge data.
The State of Oregon is unique in that a 1987 law requires hospitals treating a child under
the age of 18 for injuries resulting from a suicide attempt to report the attempt to the
Oregon Health Division. This data source provides important information for youth
suicide prevention programming in Oregon.
ii Other possible sources of data on suicide attempts include mental health agencies,
psychiatric hospitals, poison control centers, universities and colleges, child death review
teamreports,emergencydepartments,andsurveys. Limitationsexistforallofthese
data sources, such as lack of detail on the circumstances surrounding the suicide
attempt. Detailed information is important because it may lead to increased knowledge
of how suicides can be prevented in the future.
Packet Pg 585
2
Attachment: Santa Clara County Suicide Prevention Strategic Plan (Suicide Prevention Policy)
Vl. Next Steps
The desired outcomes for each of the five recommended strategies in the Suicide Prevention
Strategic Plan (the Plan) cannot be achieved through isolated actions or services. The scope of
the problem and the need for community-wide support necessitates long-term, sustained and
coordinated effort by many stakeholders. There is no time to waste. The goal of this section is
to commit Santa Clara County to concrete actions that will tangibly improve suicide prevention
activities in the County by December 31, 2010. These actions will lay the foundation for full
implementation of the Plan.
Infrastructure. These actions are intended to create the requisite infrastructure to implement,
coordinate and report on suicide prevention efforts throughout the county.
1) Establish a Suicide Prevention Oversight Committee (SPOC). The SPOC will advise the
Board of Supervisors on the implementation of the Plan and will submit semi-annual
progress reports to the Board of Supervisors" Health and Hospital Committee (HHC). The
SPOC will work closely with the Mental Health Department (MHD), which will serve as the
lead agency in coordinating suicide prevention services/activities throughout the county.
2) Hire a Suicide Prevention Coordinator. To ensure timely facilitation and ongoing support
for implementation of the Plan, the MHD will designate one full-time staffperson as the
County's Suicide Prevention Coordinator.l This staff person also will serve as the County's
liaison to the California Office of Suicide Prevention.
3) Form Four Work Groups. As indicated in the Plan, the SPOC will form four work groups,
each of which will plan for, oversee, and report on the implementation and effectiveness of
its assigned strategies. The following four yvork groups will develop implementation plans
for each strategy:
a) AnlnterventionStrategiesworkgroup(Strategyl)willcompileacomprehensive
overview of existing and needed intervention strategies. It will coordinate a system of
suicide prevention services.
b) A Communications Practice work group (Strategies 2 and 3) will have oversight over all
resulting communication projects and activities related to suicide prevention, both
locally and regionally, including a Community Education Campaign.
c) A Policy and Governance work group (Strategy 4) will advocate for the adoption of
suicide prevention policies and protocols among agencies, systems and organizations
throughout the County.
d) A Data Committee (Strategy 5) wilt define the Plan's data requirements, sources and
reporting processes.
o
' This assumes that the Board of Supervisors and the State will approve a fifth MHSA Prevention & Early
Intervention project.
Early Implementation. Upon approval from the Board of Supervisors, the MHD will proceed
with the following actions which will either immediately reduce suicides or develop new
funding sources for suicide prevention activities.
1) Develop Formal MHSA PEI Project for Suicide Prevention. The QHD will develop a fifth
Prevention and Early Intervention (PEI) Project for Suicide Prevention and hire a full time
(1.O FTE) Suicide Prevention Coordinator. If approved by the State, "PEI Project 5" will fund
approximately 5800,000 in new suicide prevention activities annually for three to four
years. Funding from this project will support activities in each of the Plan's five strategies,
laying the foundation for new services and resource development. The SPOC will devise a
process to apportion available funding to each of the five strategies.
2) Implement Listening Campaigns. The Suicide Prevention Coordinator will begin
implementing "Listening Campaigns" to promote mental health and suicide prevention
awareness. The Listening Campaigns also will serve as an ongoing vehicle for incorporating
residents' input into the Plan's implementation.
3) Make Formal Connections to Statewide Suicide Prevention Efforts. The MHD will actively
coordinate with and leverage existing statewide suicide prevention efforts, including the
activities of the California Mental Health Services Authority (CalMHSA). The MHD"s goals
are to influence the development of statewide programs and to ensure that local funds -
which have been assigned to support statewide PEI projects-have an impact on local
efforts.
4) €mplement Approved Suicide Prevention-Related PEI Plans.
a) "First Break" Treatment Programs. Under PEI Project 3, the MHD will initiate services
to help individuals, especially for adolescents and Transitional Age Youth (16-25),
address the onset of serious psychiatric illness (with psychotic features).
b) Community Education and Training. Under PEI Project 1, the MHD will increase mental
health literacy and reduce stigma and discrimination within underserved cultural
communities by implementing Mental Health First Aid programs.
c) Integrated Behavioral Health. The MHD will implement early intervention services in
community-based, primary care clinics to serve approximately 4,200 patients annually
(once fully operational).
d) Gatekeeper Training. The MHD will implement "gatekeeper" programs for older adults.
The above concrete actions will augment current suicide prevention efforts. Modifications or
expansion of the aforementioned programs will be influenced by the SPOC as it implements the
Plan's five strategies.
Attachment: Santa Clara County Suicide Prbvention Strategic Plan (Suicide Prevention Policy)
Vll. Appendix
Attachment 1: Suicide in Santa Clara County by Zip Code, 2000-2006 Suicide-Homicide
Comparison Table
Attachment 2: Santa Clara County Community Agencies and Programs that Interface
with Suicide Attempters, Victims, and Loved Ones
Attachment 3: Best Practices Recommendations
Attachment 4: Summary of Public Forum Input
Attachment 5: Palo Alto Unified School District Suicide Prevention and Mental Health
Promotion Policy
Attachment 6: References
Packet Pg 590
Attachment: Santa Clara County Suicide Prbrintion Strategic Plan (Suicide Prevention Policy)
Attachment 1. Suicides in Santa Clara County by Zip Code, 2000-2006, and
Suicide-Homicide Comparison Table
ZIP CITY 2000 2001 2002 2003 2004 2005 2006
SUI HOM S[TI HOM SUI HOM SUI HOM SUI HOM SUI HOM
SU
I Hl
94022
Los
Altos i o 3 o o o o o o o o o 3 o
94024
Los
Altos o o 3 o 4 o 71 II-o 2 o l o L I
o
L.A. &
L.A.
Hills
Totals 1 6 4 6 2 1 8
94040
Moun-
tain
View 2 o €li
lo 2 o
ffi
u
I
l 4 l l o 3 o
94041
Moun-
tain
View [o o o 1 o o o 2 I o o l o
94043
Moun-
tain
View 1 o
r
1
r
1,u o 2 o 2 o o 1
M. E
Totals 7 11 7 9 8 3 4
94085
Suruiy-
vale o o C o o
I
0,f7 1.o o o o 3 o
94086
Stinny-
vale Ft!!i2 %g,l1,s l'
2 w 1.m l 3 2 l l.iO
94087
Sunny-
vale 4 o l,.i o
I
3
I
l 2
I
o MWo 14 .:It
- 'I
1
I
o
94089
Sunny-
vale o o l,,l o 2 o o o 2 l 3 o 2 1
Sunny-
vale
Totals 13 17 16 13 18 10 10
94301
Palo
Alto 2 o 2 o 2 o 3 2 s o 1 o 2 o
94303
Palo
Alto 2
I
5,l I 5 2 4 1 9 L I
41 [11 o 7
94304
Palo
Alto o o o o o o o o o 1 o o o o
94305 Stan-ford o o 1 o o o o o o o l o o o
94306
Palo
Alto o I 2 o 2 o 2 o n4 2 2 01 [,I
I
95002 Alviso o o o o o o o o o o o o o o
ZIP CITY 2000 2001 2002 2003 2(104 2005 2006
SUI HOM SUI HOM SUI HOM SUI HOM SUI HOM SOT HOM 3-JI I r'
95008
Camp-
bell I o 2 o
ffi
4
I
iO 4 1 'a 10 1 3 e l' 3
j0
I I
95014
Cuper-
tino [:o 2 o 1 2 o '2 o 2 o II:1,
95020 Gilroy !1. -i 5 3 C:!l 2 2 3 o €12 3 I
95030
Los
Gatos o o 2 o I o 3 o l l 2 o 3 o
95032
Los
Gatos r o 2 o o o 3 .1 j7 o if, Ilo 1 o
95035
Milpi-
tas 3 l 2 1 3 o 1€'l3 Ll 2 L!I
3 1 1
l-"'-
95037
Mor-gan
Hill o l 3 o i!!!f!o r
I
10 I1:'l 3 1 3 o
l' -I
95046
San
Martin o o o 2 l o 1 o o o o o l o
95050
Santa
Clara 2 2 3 o 1 2 [71lo .1 2 2 2 l 2
95051
Santa
Clara L o 2 o 7 :3 1 I14' ff o 2 3 L o
95054
Santa
Clara o o I 1 o o 1 l I 2 o (-
S.C.
Totals 8 6 5 6 6 5 7
95070
Sara-
toga 3 1 2 o 3 o 3 (ag 5 1 I o 1
I
95110 San Jose 3 o o 2 o o 3 1 o I o 2 o o
95111 San Jose tri 3 r=+o 1 2,q% I 2 3 2 m 1 3 2
95112 San Jose 3 3 2 3 m _1 Il 4 3 3 3 oi i5 I 1
95113 San Jose o o o 1 o o o o l o 2 01 1 o
95116 San Jose 1 3 l 3 13,5 1 2 3 4 2 =il I I 1
95117 San Jose LJ o l o 2 o 2 o 3 I 1 o
-l
2 4
95118 San Jose o 2 2 1 '2 o o 21 [.4 1 l 2 o
95119 San Jose o o o o o o l I o o o o 2 1
95120 San Jose 2 o 2 o z 3 o o 2 l o o i€o
95121 San Jose 3 o 3 I ' 1'o I 1 l l o o o 1
95122
95123
95124
San Jose
San Jose
San Jose
3
am
4
I I 2 1 3 1 4 1 5,'m_3 1 6
2
0,
3
14 J
2
o
I,S '
3
1
o
3
mmai H ,!wags o m_i o 2 o
l_(=_ ___.o its l 3 1
95125
95126
San Jose
San Jose
aaam
1
l
1
3
1
I
4
2
2
l
o
51
3 sl IIl!l II 4 II o 2 I
l 2 o l o
0
Packet Pg. 593
ZIP CITY 2000 2001 2002 2003 2(104 2005 2006
SUI HOM SUI HOM SUI HOM SUI HOM SUI HOM SUI HOM SUI H(
San Jose I 2 rl ,3 3 7
'
-5 €I j 3 I 4
95128 San Jose [u ,1 3 il 1 1 51 1 o 1 2 o 2 o
95129 San Jose o o t l l o 1 o 2 o 2 3 o o
95130 San Jose 2 o 1 o o o 1 o l 1 'O o 1 o
95131 San Jose 2 1 3 o o o o 1 l o o o o o
95132 San Jose 3 l 2 o r='2 3 1 F4 IiO 1 l 3 I
95133 San Jose l I o 1 l 1 I o I 2 1 3 l 2
95134 San Jose o o o o 1 o I l 3 o 1 o o 1
95135 San Jose 7 o l o 1 o 2 o l o o o o o
95136 San Jose l I 3 o l o 3 o 1 1 2 o 1 I
95138 San Jose o o o o o o I o 2 o o o o o
S.1
Totals 65 47 61 65 73 60 47
TOTAL 120 120 125 133 156 112 109
1-3
4-6
7 - 10 s
Califomia Department of Finance, Demographic Research Unit, Estimates of Populatiori of Califomia Cities, 2006:
Campbell 36,984
Cupertino 55,000
Gilroy 48,448
Los Altos and Los Altos Hills 36,065
LosGatos 28,971
Milpitas 65,235
MonteSereno 3,511
MorganHill 37,066
MountainView 71,947
PaloAlto 62,108
SanJose 953,058
SantaClara 110,700
Saratoga 30,815
Sunnyvale 133,458
Unincorporated 98,244
TotalCounty-2006Estimate 1,771,610
Packet Pg. 594
Attachment: Santa Clara County Suicide Prbvention Strategic Plan (Suicide Prevention Policy)
Attachment 2. Santa Clara County Community Agencies and Programs that
Interface with Suicide Attempters, Victims, and Loved ones
Program Name
Suicide and Crisis
Services (SACS)
Operated by: County
Mental Health
Department
County Mental Health
Services
Operated by: County
Mental Health
Department
Community-based
organizations (CBOs)
Operated by: County
Mental Health
Department
EMQ's Families First
Child and Adolescent
Mobile Crisis Program
Operated by: County
Mental Health
Department
Emergency Psychiatric
Services (EPS)
Operated by: County
Mental Health
Department
Mental Health Urgent
Care (MHUC)
Operated by: County
Mental Health
Department
Description
This county program provides residents with access to a 24-hour telephone hotline.
Operated primarily by 100 volunteers and with less than S90,000 in annual funding,
the program fields over 35,000 calls annually from suicidal clients, concerned
family members and other residents in crisis. Approximately 20% of calls are from
individuals with suicide ideation. SACS also supports grieving families and friends
through its Survivors of Suicide Group and partners with grief /loss support
programs operated by Kara and the Bill Wilson Center's Centre for Living with
Dying. Several times each year, SACS staff members provide training to various
community organizations on suicide assessments and crisis intervention.
This county program provides an array of mental health services to primarily Medi-Cal
beneficiaries and those who are uninsured. Approximately 22,000 children,
;qrlnlescents, young adults, adults and seniors receive services annually through a
network of County-operated and contracted programs.lo5 Services range from
outreach, peer advocacy, and case management to clinical care and support in a variety
of community, outpatient, residential and day programs.
CBOs account for approximately half of the public mental health system's capacity, and
they are a key component of the entire public safety net. These CBOs address county
residents' behavioral health needs, including mental health concerns that involve the
risk of suicide. The CBOs also leverage other funding sources and operate a variety of
programs that address behavioral health needs that are not funded by the County
Mental Health Department, such as the Status Offender Services network.
This program responds to the acute psychological crises of minors, offering services in
the home, at school and in the community. The EMQ Team responds 24/7 and often
facilitates hospitalization and/or crisis intervention services to children and youth who
are suicidal.
Operated at Valley Medical Center, EPS is the single psychiatric emergency
receiving center in the county. The program is key in responding to acute mental
health crises that often involve risk of suicide. The 24/7 EPS program provides
a intervention services to individuals experiencing acute psychiatric episodes and
who may be a danger to themselves or others. Annually, approximately 7,500
individuals arrive at EPS on "5150 holds," brought by law enforcement officers and
others. The large majority ofinvoluntary holds specify the "danger to self" criteria.
This voluntary unlocked county-run program also provides residents with crisis
intervention services. Services at MHUC, which are available to walk-ins, are available
daily from 8 am to 10 pm. Clients, family members, law enforcement agencies and
other first responders are encouraged to use MHUC to meet the needs of individuals
experiencing severe emotional or psychological distress, including thoughts of self-
harm.
Packet Pg. 596
Police Crisis
Intervention Training
(CIT)
Operated by: County
Mental Health
Department
Golden Gateway
Operated by: County
Catholic Charities
Self-Help Centers
Operated by: County
Mental Health
Department
Ethnic and Cultural
Community Advisory
Committees (ECCACs)
Operated by: County
Mental Health
Department
Toll Free Veterans'
Suicide Prevention
Hotline
Operated by:
Department of
Veterans' Affairs
Veteran Suicide Chat
Service
Operated by: Veterans
Administration
VA Palo Alto and Menlo
Park Division
Operated by: Veterans
In partnership with law enforcement agencies, the MHD is continuing to enhance law
enforcement officers' abilities to manage crises involving mentally ill residents. In
addition to advocating for more required mental health training for cadets, the MHD is
working to ensure that all officers receive Crisis Intervention Training (CIT). In addition
to reducing the need for using deadly force, this 40-hour prog,ram can save lives by
giving officers tools they can use when encountering individuals who intend to lose
their lives by intentionally threatening police officers (i.e., suicide by police).
In addition to providing intensive case management and therapy to severely
mentally ill older adults, this program conducts extensive outreach to and mobile
;q'sessments of homebound or shut-in seniors who would benefit from mental
health services. Golden Gateway's services are important for preventing suicides in
California. Adults aged 75 and over have the highest rates of suicide (California
Strategic Plan on Suicide Prevention, June 2008).
These county programs offer drop-in self-help and peer support for mental health
consumers. Three programs provided in North, Central and South county locations offer
the unique opportunity for consumers to find support and compassion within a
supportive peer-run setting.
Similar to the philosophy of self-help centers, the ECCACs are family and consumer
support teams from eight ethnic and cultural communities who offer support and
linkage to services.
1-800-273-TALK (8255), and press 'T'. The Department of Veterans Affairs' (VA) The
Veterans Health Administration (VHA) has founded a national suicide prevention
hotline to ensure veterans in emotional crisis have free, 24/7 access to trained
counselors. To operate the Veterans Hotline, the VA partnered with the Substance
Abuse and Mental Health Services Administration (SAMHSA) and the National Suicide
Prevention Lifeline. Veterans can call the Lifeline number, 1-800-273-TALK (8255), and
press 'T' to be routed to the Veterans Suicide Prevention Hotline.
www.suicidepreventionlifeline.org. Veterans may use Veterans Chat without
identifying themselves or revealing any personal information unless the person chooses
to do so. Mental health clinicians on the Veterans Chat do not provide treatment or
care. The clinicians will only provide information on services, guidance and assistance,
andhelpfulonlineresourcesviaVeteransChat. IftheVAmentalhealthclinicianwith
whom you are chatting decides that you are a danger to yourself and crisis intervention
is needed, we will ask you to provide a phone number where VHA Suicide Hotline staff
may make contact you. However, even at this time, you do not have to provide that
information.
The Veterans Administration, while not organized by counties, provides a
comprehensive array of medical and mental health services for veterans through the
VA Palo Alto Health Care System. Available mental health services include 80 acute
psychiatric beds; mental health emergency services; voluntary residential rehabilitation
programs for PTSD, substance abuse, and homeless services; outpatient mental health
treatment including specialty services designed for women veterans and 01F/OEF
recent returnees, intensive case management, and specialized evidenced-based
Administration interventions for family therapy, PTSD, and addiction treatment. Suicide Prevention
Coordinators at the Palo Alto VA track and coordinate intervention and care services for
veterans who are at high risk for suicide. Services are provided at a number of VA sites
including Palo Alto, Menlo Park, San Jose, Monterey, Capitola, as well as at Vet Centers
located in Redwood City and San Jose.
Suicide Prevention Lifeline 1-800-273-8255 (TALK) press 1 for veterans
Veteran Suicide Chat Service www.suicidepreventionlifeline.org
VA Palo Alto Telephone Care Line 800-455-0057
VA Palo Alto Main Number650-493-5000
Outpatient Care Clinic Community-based outpatient clinic in San lose and local Vet Centers. The suicide
coordinators at the Palo Alto VA track and coordinate intervention and care services for
Operated by: Veterans veterans who are at high risk for suicide.
Administration
o
o
Attachment: Santa Clara County Suicide Prb,ention Strategic Plan (Suicide Prevention Policy)
Attachment 3. Best Practices Recommendations
National Strategy for Suicide Prevention Ten Prevention Programs
DescriptionProgram Name
1) American Indian Life
Skills Development/Zuni
Life Skills Development
The curriculum includes anywhere from 28 to 56 lesson plans covering topics such
as building self-esteem, identifying emotions and stress, increasing communication
and problem-solving skills, recognizing and eliminating self-destructive behavior,
learning about suicide, role-playing around suicide prevention, and setting
personal and community goals. The curriculum typically is delivered over 30 weeks
during the school year, with students participating in lessons 3 times per week.
Lessons are interactive and incorporate situations and experiences relevant to
American Indian adolescent life, such as dating, rejection, divorce, separation,
unemployment, and problems with health and the law. Most of the lessons include
brief, scripted scenarios that provide a chance for students to employ problem
solving and apply the suicide-related knowledge they have learned.
2) CARE (Care, AsSess,
Respond, Empower)
CARE (Care, Assess, Respond, Empower)-formerly called Counselors CARE (C-
CARE) and Measure of Adolescent Potential for Suicide (MAPS)-is a high school-
based suicide prevention program targeting high-risk youth. Includes a 2-hour,
one-on-one computer-assisted suicide assessment interview followed by a 2-hour
motivational counseling and social support intervention. The counseling session is
designed to deliver empathy and support, provide a safe context for sharing
personal information, and reinforce positive coping skills and help-seeking
behaviors. CARE expedites access to help by connecting each high-risk youth to a
school-based caseworker or a favorite teacher and establishing contact with a
parent or guardian chosen by the youth. The program also includes a follow-up
reassessment of broad suicide risk and protective factors and a booster
motivational counseling session 9 weeks after the initial counseling session. The
goals of CARE are threefold: to decrease suicidal behaviors, to decrease related
risk factors, and to increase personal and social assets. CARE assesses the
adolescent's needs, provides immediate support, and then serves as the
adolescent's crucial communication bridge with school personnel and the parent
or guardian of choice. The CARE program is typically delivered by school or
advanced-practice nurses, counselors, psychologists, or social workers who have
completed the CARE implementation training program and certification process.
Although CARE was originally developed to target high-risk youth in high school-
particularly those at risk of school dropout or abusing substances-its scope has
been expanded to include young adults (ages 20 to 24) in settings outside of
schools, such as health care clinics.
3) CAST (Coping and
Support Training)
CAST (Coping And Support Training) is a high school-based suicide prevention
program targeting youth 14 to 19 years old. CAST delivers life-skills training and
social support in a small-group format (6-8 students per group). The program
consists of 12 55-minute group sessions administered over 6 weeks by trained high
school teachers, counselors, or nurses with considerable school-based experience.
CAST serves as a follow-up program for youth who have been identified through
screening as being at significant risk for suicide. In the original trials, identification
of youth was done through a program known as CARE (Care, Assess, Respond,
Empower), but other evidence-based suicide risk screening instruments can be
used. CAST's skills training sessions target three overall goals: increased mood
Packet Pg 600
d
4) Columbia University
TeenScreen
5) Emergency Room
Intervention for
Adolescent Females
management (depression and anger), improved school performance, and
decreased drug involvement. Group sessions incorporate key concepts, objectives,
and skills that inform a group-generated implementation plan for the CAST leader.
Sessions focus on group support, goal setting and monitoring, self-esteem,
decision-making skills, better management of anger and depression, "school
smarts," control of drug use with relapse prevention, and self-recognition of
progress through the program. Each session helps youth apply newly acquired
skills and increase support from family and other trusted adults. Detailed lesson
plans specify the type of motivational preparation, teaching, skffls practice, and
coaching activities appropriate for at-risk youth. Every session ends with
"Lifework" assignments that call for the youth to practice the session's skills with a
specific person in their school, home, or peer-group environment.
The Columbia University TeenScreen Program identifies middle school and high
school-aged youth in need of mental health services due to risk for suicide and
undetected mental illness. The program's main objective is to assist in the early
identification of problems that might not otherwise come to the attention of
professionals. TeenScreen can be implemented in schools, clinics, doctors' offices,
juvenile justice settings, shelters, or any other youth-serving setting. Typically, all
youth in the target age group(s) at a setting are invited to participate.
The screening involves the following stages:
1. Before any screening is conducted, parents' active written consent is required
for school-based screening sites and strongly recommended for non-school-
based sites. Teens must also agree to the screening. Both the teens and their
parents receive information about the process of the screening, confidentiality
rights, and the teens' rights to refuse to answer any questions they do not
want to answer.
2. Each teen completes a 10-minute paper-and-pencil or computerized
questionnaire covering anxiety, depression, substance and alcohol abuse, and
suicidal thoughts and behavior.
3. Teenswhoseresponsesindicateriskforsuicideorothermentalhealthneeds
participate in a brief clinical interview with an on-site mental health
professional. If the clinician determines the symptoms warrant a referral for an
in-depth mental health evaluation, parents are notified and offered assistance
with finding appropriate services in the community. Teens whose responses do
not indicate need for clinical services receive an individualized debriefing. The
debriefing reduces the stigma associated with scores indicating risk and
provides an opportunity for the youth to express any concerns not reflected in
their questionnaire responses.
Emergency Room Intervention for Adolescent Females is a program for teenage
girls 12 to 18 years old who are admitted to the emergency room after attempting
suicide. The intervention, which involves the girl and one or more family members
who accompany her to the emergency room, aims to increase attendance in
outpatient treatment following discharge from the emergency room and to reduce
future suicide attempts. A review of the literature suggests that factors related to
treatment noncompliance following a suicide attempt include family discord,
maternal psychopathology, attempter depression, and negative experiences with
emergency room staff. The intervention consists of three components designed to
improve the emergency room experience for the adolescent and family, thereby
changing the family's conceptualization of the suicidal behavior and expectations
abouttherapy. First,atwo-hourtrainingisconductedseparatelywitheachofthe
o
o
six groups of staff working with adolescents who have attempted suicide. Second,
the adolescents and their families watch a 20-minute videotape, filmed in Spanish
and dubbed in English, that portrays the emergency room experience of two
adolescents who have attempted suicide. Last, a bilingual crisis therapist delivers
a brief family treatment in the emergency room.
6) Lifelines Curriculum Lifelines is a comprehensive, school-wide suicide prevention program for middle
and high school students. The goal of Lifelines is to promote a caring, competent
school community in which help seeking is encouraged and modeled and suicidal
behavior is recognized as an issue that cannot be kept secret. Lifelines seeks to
increase the likelihood that school staff and students will know how to identify at-
risk youth when they encounter them, provide an appropriate initial response, and
obtain help, as well as be inclined to take such action.
Lifelines includes a set of components to be implemented sequentially: a review of
resources and establishment of administrative guidelines and procedures for
responding to a student at risk; training for school faculty and staff to enhance
suicide awareness and an understanding of the role they can play in identifying
and responding to a student with suicidal behavior; a workshop and informational
materials for parents; and implementation of a curriculum for students, the
Lifelines Curriculum, to inform students about suicidal behavior and discuss their
role in suicide prevention.
The research reviewed for this summary assessed only the Lifelines Curriculum,
the last component to be implemented in the,larger Lifelines program.lt consists
of four 45-minute or two 90-minute lessons that incorporate elements of the
social development model and employ interactive teaching techniques, including
role-play. Health teachers and/or'guidance counselors teach the lessons within the
regular school health curriculum. The Lifelines Curriculum was developed
specifically for students in grades 8-10 but can be used with students through 12th
grade.
7) PROSPECT (Prevention
of Suicide in Primary
Care Elderly:
Collaborative Trial)
PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) aims
to prevent suicide among older primary care patients by reducing suicidal ideation
and depression. The intervention components are: (1) recognition of depression
and suicide ideation by primary care physicians, (2) application of a treatment
algorithm for geriatric depression in the primary care setting, and (3) treatment
management by health specialists (e.g., nurses, social workers, and psychologists).
The treatment algorithm assists primary care physicians in making appropriate
care choices during the acute, continuation, and maintenance phases of
treatment. Health specialists collaborate with physicians to monitor patients and
encourage patient adherence to recommended treatments. Patients are treated
and monitored for 24 months.
Implementation of the program relies on educating primary care physicians to
recognize symptoms and apply a clinical algorithm based on depression treatment
guidelines for older patients from the American Psychiatric Association, the
Agency for Healthcare Research and Quality, and the Texas Department of Mental
Health. The recommended first line of treatment is citalopram, a selective
serotonin reuptake inhibitor (SSRI). If citalopram does not achieve the desired
result, other medications may be added or substituted. Interpersonal
psychotherapy may also be used in addition to or instead of pharmacological
treatment.
8) Reconnecting Youth Reconnecting Youth: A Peer Group Approach to Building Life Skills (RY) is a school-
based prevention program for students ages 14-19 years that teaches skills to
buffd resiliency against risk factors and control early signs of substance abuse and
emotional distress. RY targets youth who demonstrate poor school achieveriient
and high potential for school dropout. Eligible students must have either (1) fewer
than the average number of credits earned for all students in their grade level at
their school, high absenteeism, and a significant drop in grades during the prior
semester or (2) a record of dropping out of school. Potential participants are
identified using a school's computer records or are referred by school personnel if
they show signs of any of the above risk factors. Eligible students may show signs
of multiple problem behaviors, such as substance abuse, aggression, depression,
or suicidal ideation.
RY also incorporates several social support mechanisms for participating youth:
social and school bonding activities to improve teens' relationships and increase
their repertoire of safe, healthy activities; development of a crisis response plan
detailing the school system's suicide prevention approaches; and parent
involvement, including active parental consent for their teen's participation and
ongoing support of their teen's RY goals.
The course curriculum is taught by an RY Leader, a member of the school staff or
partnering agency who has abilities as a "natural helper," has healthy self-esteem,
is motivated to work with high-risk youth, and is willing to comply with
implementation requirements.
9) SOS Signs of Suicide SOS Signs of Suicide is a 2-day secondary school-based intervention that includes
screening and education. Students are screened for depression and suicide risk
and referred for professional help as indicated. Students also view a video that
teaches them to recognize signs of depression and suicide in others. They are
taught that the appropriate response to these signs is to acknowledge them, let
the person know you care, and tell a responsible adult (either with the person or
on that person's behalf). Students also participate in guided classroom discussions
aabout suicide and depression. The intervention attempts to prevent suicide
attempts, increase knowledge about suicide and depression, develop desirable
attitudes toward suicide and depression, and increase help-seeking behavior.
10) United States Air Force
Suicide Prevention
Program
The United States Air Force Suicide Prevention Program (AFSPP) is a population-
oriented approach to reducing the risk of suicide. The Air Force has implemented
11 initiatives aimed at strengthening social support, promoting development of
social skills, and changing policies and norms to encourage effective help-seeking
behaviors. AFSPP's 11 initiatives include:
Leadership Involvement
Suicide Prevention in Professional Military Education
Guidelines for Use of Mental Health Services
Community Preventive Services
Community Education and Training
Investigative Interview Policy
Critical Incident Stress Management
Integrated Delivery System (IDS)
Limited Privilege Suicide Prevention Program
Behavioral Health Survey
Suicide Event Surveillance System
o
American Foundation for Suicide Prevention: Suicide Prevention Resource Center's
Evidence-Based Practices
DescriptionProgram Name
1. Reduced Analgesic
Packaging
2. Emergency Room
(ER) Means
Restriction
Education for
Parents
In response to an increasing number of self-poisonings with
analgesics (acetaminophens and salicylates) in the United Kingdom,
Parliament passed legislation in 1998 limiting the pack sizes of these
drugs. Before the legislation, pharmacies could sell unlimited
amounts of analgesic tablets. After legislation, pharmacies were
limited to 32 tablets per sale and non-pharmacy outlets were limited
to 16 tablets per sale. In addition to packaging limits, specific
printed warnings about the dangers of overdose with these
analgesics were included with all sales.
The goal of this intervention is to educate parents of youth at high
risk for suicide about limiting access to lethal means for suicide.
Education takes place in emergency departments and is conducted
by department staff (an unevaluated model has been developed for
use in schools). Emergency department staffs are trained to provide
the education to parents of child who are assessed to be at risk for
suicide. Lethal means covered include firearms, medications (over-
the-counter and prescribed), and alcohol. To help with the safe
disposal of firearms, collaboration with local law enforcement or
other appropriate organizations is advised. The content of parent
instruction includes:
1. Informing parent(s), apart from the child, that the child was at
increased suicide risk and why the staff believed so;
2. Informing parents that they can reduce risk by limiting access to
lethal means, especially firearms; and,
3. Educating parents and problem solving with them about how to
limit access to lethal means.
Additional Evidence-Based Practices from literature review
A Made' Commun"y A Model Community Education Program on Depression and Suicide
Educa'on Program on in Later Life, developed by Clara Pratt, PhD, Vicki Schmall, PhD,
Depress'on and su"de Willetta Wilson, PhD, and Alida Benthin, MA, Oregon State
'n la'er L'fe University Gerontology Department. This is a 3-hour multimedia
program on depression and suicide in later life. Designed for
families, older adults, and service providers, the program provides
information and teaches skills needed to recognize and respond to
depression and suicidal behavior in the elderly. Compared with a
Gatekeeper Training
control group, program participants had significant gains in
knowledge and in their intent to take appropriate action in support
of a depressed person.
The QPR Institute offers comprehensive suicide prevention training
programs, educational and clinical materials for the general public,
professionals, and institutions. (QPR stands for how to Question,
Persuade and Refer someone emitting suicide warning signs.) QPR is
taught by certified instructors in a minimum of one hour, but often
extended to two hours for role-play and practice. The adult learning
program teaches lay and professional gatekeepers how to recognize
a mental health/suicide emergency, how to Question the validity of
suicidal communications, and how to Persuade and Refer someone
at-risk to the next level of intervention. The goal of gatekeeper
training is to enhance the probability that a potentially suicidal
person is identified and referred for assessment and care before an
adverse event occurs. Across our county there are several
institutions already providing this training such as Foothill College.
Somewhat related to this is ACT, which also was recommended by
committee members. Initiated in 2007, a Navy suicide prevention
campaign asks sailors to "ACT" now to save a life.ACT is a three-step
process designed to heap determine if someone is suicidal and to
prevent them from hurting themselves. It stands for: Ask- ask the
person if they are thinking of hurting themselves, C- listen and let
the person know they are not alone, and Treatment- get your
shipmate to help as quickly as possible; such as the duty officer,
chaplain, friend, medical personnel, or others who can help.
Attachment 4. Input from Public Forum
Summary of Public Forum Comments and Input:
On April 28, 2010, the Santa Clara County Suicide Prevention Public Forum drew 108
community participants, 6 of whom were monolingual Vietnamese speakers, and 2 were
bilingual Mandarin/English and requested the use of interpreters. The purpose of this forum
was to provide an opportunity for the community to provide feedback on the work completed
by the Suicide Prevention Advisory Committee and to have their comments inform the Plan.
Participants were offered multiple methods to provide their feedback:
s Writing comments on Post-It notes which were placed directly onto the posters of the
work completed to date,
a Comment Cards, and
s Small discussion groups facilitated by Advisory Committee members.
While not every comment was able to be included in the plan, all comments are recorded
verbatim below.
The vast majority of the comments fall into one of the six themes summarized below:
ss Youth who are transitioning from dependent minor status to independent young adult
status-regardless of being enrolled in secondary education or in the workforce.
a Parental education. The public recommended trainings geared to parents and foster
parents to recognize their child's inner turmoil, address the issue of youth who are
raised more by nannies and have low parental involvement in their lives.
a Geographic isolation. Some strategies should address the issue of geographic isolation
for youth as well as older adults already included in the plan.
s Sharing stories. Participants recommended that individuals who had survived their own
attempted suicide share their stories to educate and inspire people.
ffl Public recognition of life savers. Participants recommended that individuals who help
bring people in crisis to an intervention resource be publicly recognized with a
certificate or award as a means to raise the profile of suicide prevention and encourage
others to consider doing the same.
a Stress and stressors, transitions and dysfunction in personal relationship skills. Several
individuals commented on homicide/suicides preceded by stressors combined with poor
coping and anger management skills. Some stressors discussed were the pressure to
achieve and succeed; divorce; loss of job; racism; all prejudicial behaviors; reentry into
society after criminal justice involvement. This issue/need should be framed as, for lack
of a better description a "tipping point."
Below is a transcript of the small group discussions based on notes taken by Advisory
Committee members. Before each comment/question an empty box means we have not
identified or addressed the main point of the comment. A black "X" indicates that the
comment submitted had already been discussed and included in the Suicide Prevention Plan
prior to the Public Forum. A blue "X" underlined indicates inclusion in the plan after the
public forum. Those comments without an "X" and not included in the plan at this point may
be considered again during the implementation phase of the process.
Santa Clara County's Mental Health Department hired consulting group MIG to draw a 12" wide,
4' tall summary of the night's input that is referred to in the notes below as a Wall Summary.
This graphic illustration is included on the Santa Clara County Mental Health Department's
Suicide Prevention website-www.sccgov.org/spac.
Addressed
b7
committee?
Comment or question
Group 1
x Encourage the community to talk about suicide and for those who have
experienced or attempted suicide to be able to share their stories.
x [We need] a systematic approach for all ages.
One that connects the steps, address all ages, honors those who died
through suicide with the gift of their stories.
x Need an instrument that would enable the community to understand
the journey one takes in even contemplating suicide - let alone
attempting or even completing suicide
x Be creative and use social network sites
X have the
category
Prevention strategies should be a separate category - not placed under
intervention
Missing best practices in state of California like Healthy Start- offer
education at a younger age.
X- PEI,
Integration
efforts
Multidisciplinary [approach] is key, look at [what] already exisit[s] i.e,
student study teams like the Education Model SST (student study teams)
utilizing multi-disciplinary experts
x Stories [are] very powerful, they can touch the heart; stories [can be usedl
to prevent/ intervene as a means [ofl outreach community is a real
experiences/ nurture the story and honor an individual.
X- Requested
data
Is there research specific to cluster/ "copycat" suicides?
x Alcohol/ substance use, meth[amphetamine] [induces a] morbid way of
thinking and [morbid] emotions, but [they are] not always connected. It
may entail body chemistry.
x Working in jails- the Mercury News is not on the front page. (Scribe's not
sure-Suppose is that suicide in jails is not given much media attention but
that it's a real issue) jail is high risk population
x Regarding the elderly, most see their doctor. How many doctors ask
directly questions of life and death and refer [them to mental health].
x Use of community centers to provide a safe environment where youth
are able to discuss, talk about the topic of suicide and support discussion
with those who've experienced traumatic events- [they can] speak about
how they coped.
x PTSD [is] connected to suicide
x Positive aspect- social networking sites or dollars, resources are cost
effective ways of reaching out and educating after an event. Questions
[can be] asked, [ie.] how is this affecting you?, etc.
x Problems [canl be worked out via [public] health model rather [than] a
disease model.
X- Listening
Campaign
P[alol A[ltol [isl using creative strategy - talking to youth. [They have
organized] 3 youth focus sessions and asked and learned from the youth.
Listen to the wisdom of the youth.
x PA hosted a youth gathering - youth were invited via social network sites -
youth showed up and openly talked about the crisis of suicide and the reality of
suicide from a young person's point of view
x Los Gatos [is an] isolated community. Folks [are] worried about [their] children
because of the isolation. [There is no] outreach and they're hurting. Outreach
in geographically isolated areas
x Strategy: School Districts with physically isolated students dealing with
trauma (i.e. suicide or cluster of suicides) can connect with other districts to
share what is being done re: outreach to geographically isolated community
members, students who live in the isolated area of the Loma Prieta School
District.
x Violence- Domestic Violence [and] homicide [are] linked to suicide:
ie. Vietnamese families killed by father who in turn kills himself.
x Companies are utilizing experts to provide workshops for employees who are to
be laid off - coping strategies, stress release techniques, etc. so that laid off
employees will have the ability and tools to cope with the anger and transition
instead of having the rage prompting the laid-off employee return to their
former place of employment with weapons, killing co-workers and possibly
themselves. Recommend policy and governance with for-profit training and
awareness
X- Communi-
cation
practices
[This requires a] paradigm shift. [Suicide is a] public health issue. [We need]
understanding. The need for propaganda (mass public awareness campaigns)
[like were used forl child seats in cars, smoking, etc. [This requires al long term
o
approach. Paradigm shift may take time but in time suicide will not be seen as
an option.
x Bring youth and adults together. Use fishbowls (held in a safe environment).
Develop [a] dialogue, share honestly and be heard.
Adults [need tol listen when there's an opportunity to provide feedback after
the youth have shared- [this applies to] numerous topics [like] identity,
sexuality, substance use, Mental health, depression, stress. Allow [the youthl
freedom to give [their] voice.
Provide'tools for communication utilizing fishbowl strategy, community
centers, and social networking sites.
x [Adults need tol remember back to [theirl youth [when we were asking] what's
the meaning of life? Where's the spirit? Is there no value in one's life? Where is
this going? [411 thel outside influences [that affect them] economy, the
government, people's spirit is dying. Neighborhoods, racial groups, a lot of
faiths, are not valued anymore. Where's one's [own] identity? [Do you] Find
meaning in your work? [411 of this needs to be] attached to the spiritual
component. Allow the spirit of life (faith) to penetrate.
x [Suicide prevention/ everythingl starts with policy. In Santa Clara County [we]
need to declare the value of life. All groups [are] affected. Need to be
grounded- all of life is valuable. Perhaps [we're] afraid to talk about the spirit.
Talk[ing] to those who are hopeless or [in a] hopeless state is not that helpful
(isthatwhatwassaid?). [Peoplelneedtheconnection,reflective
relationships, need to be valued and appreciated. All endeavors [should] come
out of that.
x Workers who are just collecting a paycheck vs. workers who are engaged,
happy, vivacious. Such agencies/institutes are welcoming, warm and those
who use the facilities are in turn happy, passionate, i.e. teachers who have a
passion that spirit shows.. The opposite is true as well, Vivacious work force
x Students do not have tools to deal with life. Adults need to come in and
hopefully they possess the tools needed. Kids gravitate to exciting teachers.
x Police Department in Los Altos (kids) parents [are] very disengaged, kids [are]
being raised By nannies. [Parents don't know that their] kids are suffering from
a tragic event, using drugs, mentally ill. Parents connect with our children.
Police: Speaker shared feeling sad, compassion and sympathy when responding
to a suicide call that involves a youth. However police often have little or no
compassion and often even feel anger when responding to a suicide or
attempted suicide call of an adult. Behaving this way is used as a means of
getting a reaction from family members, spouse, significant other.
Differentiated police response to suicide (of youth versus adult)
Group 2- This group (comments below) consisted of representatives from Redwood Middle
School, the Director of Health Services from West Valley College, representatives from an
Independent Living Program, a representative from Elmwood Correctional Facility, and a few
community members. The group mainly discussed building a common language, educating on
o
Packet Pg 609
all levels, better training volunteers, and providing more resource centers.
Addressed
b7
committee?
Comment or question
X_One resident feels that parents do not have tools for prevention. We need to
have early education, awareness, and focus on mental health. Suggestion: Offer
information once the mother gives birth at the hospital.
x We need to develop a method to help the community understand that mental
health is OK. Promote help seeking behavior
x Elmwood representative feels that we need to educate within the correctional
facility and help women cope with their emotions as they readapt into society.
x A local feels many (community members) believe that more awareness would
lead to more suicidal cases-we must somehow lower the stigma, and we need
more educators to be involved to help increase awareness. "Silence is killing
them". Stigma reduction
x Another local would like to see more involvement with survivors. Professionals
have great knowledge about the subject, but having a resource with the same
experience will have a larger impact and understanding. Sharing stories, peer
programs
x We need to train more volunteers who want to prevent, educate, and aid
mental health.
A representative from independent Living Program states that there is a lack in
financial aid. We have resources outreaching to schools. However, we have
forgotten about those who are not in schools. Perhaps, we should build
resources in Juvenile facilities too.
@ Where are other resource centers other than schools?
* Can we provide financial aid to help those with mental health issues?
x We have sex education, drivers' education, etc. But we don't have a program
for mental health? Awareness and education
x We do have a program called Mental Health First Aid-perhaps we need more
promotion.
Group 3- Participants (comments below): Community Member (wife of a man who committed
suicide); Doctor; LACY Member (Social Worker); Council Member, Palo Alto (son had mental
health issues); Community member (son committed suicide); Community Member-2n" Harvest
Food Bank; Mental Health Social Worker; School Psychologist; School Counselor
x The group discussed the need to have forums that include not only
psychologists and social workers but also family members of suicide victims and
those who have attempted suicide to discuss their personal experiences,
system failures and warning signs. Listening Campaigns
X/ 2 Many of our group discussed the need to have a strong prevention strategy
and to have discussions with children when they are young and the need to
have talking points for pre-teens.
x Our group also discussed the importance of sharing personal experiences and
warning signs. Share personal stories
x Our group discussed the lack of availability of services/resources at schools
and the need to have a 24 hour telephone number to call to access mental
health services.
x We also discussed the need to have teens understand when they have to make
a call to someone when they suspect that their friend is having difficulty. This
might put adolescents in a bad position however when someone's life is in
jeopardy it is critical to call someone who can slow things down and make an
assessment (adult, law enforcement, teacher, counselor, mental health
professional, clergy). So an education strategy designed to educate young
people about getting their friend help would be an asset and would be a
valuable asset for our youth.
x One group member was very complimentary of the QPR.
x The Doctor wanted to hear more about how we can communicate within the
various communities to ensure that people are not slipping through cracks.
x
x
The matter of de-stigmatizing mental health was discussed widely. We also
talked about how we need to have a paradigm shift-much like how our
community has changed its views on drunk-driving. We thought that we could
learn some lessons from MADD and that they could be a model for changing
the discussion on mental health in the community.
Addressed
b7
committee?
Comment or question
Group 4
x Some of our group was surprised about the data on the frequency of suicide
among seniors.
x A couple of group members remarked that there was a need to have post-
incident care or post 5150 care to ensure that family members and the patient
were aware of the resources available and that they were not experiencing
destructive tendencies.
x Our entire group agreed about the importance of the community ownership
and that we all have a responsibility.
x One of the Community members announced that Stanford University Medical
School has a Bi-Polar Education Forum involving families, educators and
researchers.
x Another community member recommended the City of Palo Alto's Family
Resource Center which offers monthly meetings to discuss resources available
to the community.
Webinar
X- CIT
Fremont Unified School District in Sunnyvale has done a Webinar on Suicide
Prevention, approximately 20 minutes long and it discusses how resources can
be accessed. They have also developed a Crisis Intervention Team at the
schools with multi-discipline resources available.
x A community member recommended that there should be specialized training
for counselors at schools when there is denial amongst parents regarding the
o
mental health issues involving their children.
We had a lively discussion about respecting the privacy of children while being
concerned about their mental well-being.
x A group member recommended having a guest speaker named Kevin Hines
come and talk about his experiences being bi-polar. Share personal stories
x One community member recommended that there be training given to
physicians about the type of medications that they prescribe to their patients
and how some could have adverse effects on them and even promote suicidal
thoughts. Training would recommend that spouses/family members would
receive information about certain types of medication and the warning signs.
Provide support to Primary Care for mental health issues.
x We also discussed the need for additional information, awareness and training
for Parents, Teachers, Firefighters and the clergy to identify those at-risk and
how to access services.
x
Plan is well written. I came to see how [such a planl can be effectively
implemented in ethnic/ cultural communities. [The] rec[ommendation]s are
summaries, but [the] specifics needed (sic) to take back to [the] communities.
x Emotions and emotional awareness aren't taught. [We need to] teach
emotional awareness/ intelligence. [The] education system can teach
emotional awareness; and should be] supporting [youthl exposed to suicides.
Youth sometimes suicide through drug abuse or car crashes. Kids now feel
more helpless and hopeless. Don't know how to fit in. Drug and alcohol use is
up. Prevention dream: Health Education would be taught in schools and
address emotions. Kids need tools.
x Fo[sterl Parents aren't mandated to take MH awareness and it's needed.
Foster parents [in] (her experience) [are] in it for [the] money. ([She is a]
former foster child) Depression, self mutilation [is] ignored. Focus on foster
parents. LotsoftrainingonMHawareness. Publicmediamessagesonwhere
to get help.
x *NAMI Member- Parents and Teachers [should work together as] allies. -Teach
teachers about [the] onset of mental illness in youth. -[Has trained] 1 school
thus far. Raise awareness among educators
x Stigma to suicide. People don't want to talk about [it], even within groups that
should be comfortable with it. *Suicide [is] "taboo" within mental health.
Mental health professionals, consumers, and their family members should be
more willing to talk about suicide, with the ease they have discussing a
diagnosis.
Challenge to confidentiality and talking to family members, [HIPPA] creates
barriers. Can doctors inform family members? How do they address [the] risk?
x Suicide cross[es] economic barriers. Suicide [Has a] huge impact on families.
office of Human Relations Commission will be focusing [on] disseminating
prevention information.
x [1] Became involved because of Palo Alto Suicides. Effectiveness of means
Packet Pg. 612
restriction as [a] prevention strategy. Focus [should be on] bridge barriers,
train track monitors. Peopl e today lack emotional connections, need to
connect with people. Increased caring, increased communication
x Schools have a huge role to play [in] [re-defining] norms, de-stigmatizing help
seeking.
x Latino community does not want to acknowledge or talk about [suicidel.
[Latinosl need more information in community. Culturally appropriate
prevention information is needed.
x Lot of education [is] missing. Don't use the word "commit" suicide because
using "committed" [makes it seem like a] crime and [reinforces] stigma. Should
use "died by suicide". Change terminology
x Kids don't feel there's a stigma, they talk about it. Adults don't want to talk
about [suicide]. De-stigmatize
x Schools have cut student support staff. Teachers have no training and are not
equipped. Educate all teachers. Don't just [trainl special education [teachers],
support staff need to know [and] recognize the signs.
x The entire community must be trained, neighbors, shops, families. [This should
be framed as al public health approach.
x Media should always inform where to get hefp.
Addressed
b7
committee?
Comment or question
Group 5
x
Q: What are the political benefits to bringing the issues to people's
awareness?
A: There's believed to be an awareness problem there's a belief there's a lot of
stigma connected to suicide though people are reluctant to speak out about
what they are feelings.
x
Q: What are the political benefits to bringing the issues to people's
awareness?
A: There's believed to be an awareness problem there's a belief there's a lot of
stigma connected to suicide though people are reluctant to speak out about
what they are feelings.
x
Q: Everyone has limited budgets, is there good information about efforts that
save the most lives...?
A: The committee has taken the position that it's a public health problem in all
communities. It's tactics/ design is to raise awareness and address what
o
strategies are most effective to prevent suicide.
x C: There are various components to address the problem but we as a
community need to gather all the various components to address the
problem; people need to be able to talk about it.
x C: Loved ones need to sacrifice the time to share; with their family members;
time to express concern; loved; etc. to let the individuals know that "they care
about them" they will be missed.
x C: Concerns around teenagers because of programs being cut; kids not being
able to access counselors or help due to the cuts. Age appropriate access to
care
x C: Due to oversized classes and lack of funding teachers can not address the
problems at hand. Schools united in awareness- budget and time limitations
x C: General overall consensus on expansion of community led services and
programs and/ or peer-led programs.
x
C: Communication seems the overarching gap like with education; desensitizing
stigma make it easy for people to talk about. The media needs to be used as
an outlet or resource; we need to build relationships with media people and
they need education and sensitivity developing relationships with media.
x C: School age kids- Offer Mental Health First Aid to be able to train the school
staff to help deal with these issues.
x C: Parents can take simple steps; do little things like having dinner with a child
that will make a difference.
x C: Several members felt that strengthening and using "natural" community
resources such as church, clubs, etc would be helpful so people could get help
there either instead of MH providers or in addition to MH provider help.
x C: We have around us everyday access to people who have attempted suicide.
Why aren't they the "go to" people leading our efforts to finding the answers of
where things broke down and what would have helped them to "not" follow
through with an attempt. Attempters Sharing their Stories
Addressed
b7
committee?
Comment or question
Group 6
Policy and Governance Advocacy
x Partnership between primary care and mental health care professionals is
c.
Policy and governance advocacy may put too many regulations in place. This
regulation's category is too broad. This may inhibit individuals from seeking
care.
x More support of primary care is needed. Individuals may not reach out to MH
professionals.
x Doctors and mental health care is not working together which is detrimental.
HIPPA [due to HIPPA/ or has HIPPA become a barrier to cared. They are
currently two separate entities that need to be one. Concern that HIPPA
inhibits MH Professionals from other providers; mandated which would impact
policy procedure. Division on whether would be a good thing or negative.
Concern to maintain confidentiality while maximizing collaborative care.
x Public Policy takes away the humanity. [We need to] a(ways go back to [the
reality] that it's about people. Regulations and policy should not become
barriers in and of themselves.
x Protection of the individual [is a] double-edged sword. [Need to] Open up
communication. Becomes less private and less people will seek help. Policies
such as mandates for reporting or asking questions may increase concern for
confidentiality and may discourage people from seeking help. [Need to find a
policy that is] more open [in sharing patient's information with loved onesl but
still protecting privacy.
x Hospitals don't report suicide attempts. Should be mandated that hospitals
report suicide attempts and that those individuals receive follow up care that is
standard protocol.
x Root causes [for suicide] need to be looked at.
Community Education & Implementation
x Outreach- Paramedics, EMS, and EMTs have no idea of [the] existing hotlines.
Law Enforcement and firefighters receive little education on these issues. May
benefit from in service-type training.
x [EMS are] taught [to] treat the injury, not the person. Felt that the SACS
training was very helpful. By recognizing potential mental illness, helps to
interact.
x Law enforcement/ EMT/ Fire fighters, (first responders) [need to have]
condensed in-service type training [and] in-depth [trainings]
Intervention
x Caltrain needs to evaluate entrances where [people] in duress can enter [the
train trackslMeans Restriction
x [Schools need tol Address bullying at schools. Parents need to be responsible
as well. [Need] outreach for child [or youth] who is being bullied to let them
know [what] resources [are in] place.
[Need] a call box at the tracks.
Addressed
b7
committee?
Comment or question- Monolingual Vietnamese Group 7
x One member shared he attempted suicide when, after being diagnosed of MH,
his family insisted that he stayed in an institution and ngt come home. stigma
x One member shared he attempted while using drugs substance use
x One member shared she thought seriously about suicide when she came to this
country, without family members, lost her job and was evicted. Social isolation,
refugee/ immigrant experience
x One member shared her husband attempted suicide due to family situation
(divorce) and is now paralyzed on one arm. Loss of loved one
Cultural ISSUES
x Recognition that Vietnamese families put a lot of pressure/expectation On
family members for achievement levels, education levels, marriage social roles
and pressure
x Severe stigma around Mental Health issues due to cultural belief that Mental
Illness is shameful, punishment, karma; we do not get services for loved ones
but hide the condition.
Policy and Governance advocacy
We ask for more compassion from the legal system, that people who commit
crimes and admit fault be forgiven, or they are led to suicide
x Strict immigration laws causes distress in individuals and families, some are led
to self-sacrifice/sacrifice
x Unemployment have caused to families to die in group. Drop in economic level
x There is a lot of stress in the workplace which can lead to suicide
Practical suggestions
An easy-to-remember short hotline number such as 5-1-1
x Recognize, give award to people who have prevented another person from
attempting suicide.
Addressed
b7
committee?
Comment or question
Group 8
x Gathering Data- [lt] really struck [a] cord about finding out the why. If we know
[the] why we may be able to figure out why not.
x
I
Stigma applies to mental illness. Hope to change viewpoint and educate [the]
public about [the] crisis of suicide; bring it out of the closet. Important for
gaining political and institutional support.
x TV advertising for prevention.
x Actuarial costs of suicide in dollars and cents. Young people are worth S11.5
million dollars for [thel economy. Talk about the money saved by providing
prevention programs. If we can sell products we should be able to sell
something good like suicide prevention.
x Cultures- [ln many cultures] mental health [is] taboo. Advertise [messages
promotingl seeking mental health [services] would reduce suicide.
x Prevention is not broken out sufficiently in the plan. Would like to focus on
Packet Pg. 616
suicide prevention rather than intervention. How do we make children feel
connected and supported? [ie. Examples of ways to connect youthl Service
Learning, Building friendships, asset building- like Project Cornerstone.
Prevention beyond Intervention.
x To do this, educate parents in families where mental health taboo exists.
School may be [the] best place to introduce this. Suggested 15-20 minutes as
part of curriculum.
x We talked about what we are doing to talk positively and supportive. What are
we doing to empower them [youth], to give them [youth] voice, make them
[youth] feel supported, develop friendships. Need to positively message this to
the community. We are teaching kids about eating healthy, exercising, we
should be teaching them about how to take care of their emotional needs.
x Decrease isolation for older communities.
x Gangs, family issues, drugs, prison
x Concern regarding how medical establishment passes out antidepressants
without education and [these] can increase [risk of] suicide. We need to get to
medical establishment['s buy-in].
Concern regarding drug company advertisements that suggest that pills fix
everything.
x [01der Adults struggle with the] Feeling of [theirl being a burden. [Suicide
should not be considered as a] selfish act.
x [01der Adults struggle with thel Feeling of overcoming death and pain.
x Middle aged: Poor economy, lost jobs.
Strategies
x Workplace education to provide education [on mental health issues and
suicide awareness], similar to Air Force Academy efforts- getting MH services is
not a bad thing. Identity may be wrapped up in job and if one loses job,
[pqople experience a] feeling of lost identity. [Stress is magnified by being]
Combined with loss of insurance. [Advocate for al Law on [requiring
businesses to issue a] page of contacts and information regarding insurance
options and resources. This could also be available as posters in
unemployment offices.
x Support groups for people feeling suicidal.
Offer trainings for Senior Management - services available and general
awareness on iSSues like domestic violence (to avoid homicide/ suicide);
depression, etc.
x Train critical professions on suicide prevention and awareness: Cops, Teachers,
Clergy. They Need to understand when to turn folks over to other services.
Cultural Issues:
x Difficult to seek outside help for mental health. [Culture dictates that people
arel supposed to be able to treat [themselvesl within the family. Cultural
values, stigma
x [lt is] Essential to have someone from the same culture reach out within a
o
culture. Culturally appropriate outreach/ inreach within a community
x Spread the word in mosques, churches, temples, etc. Clergy would likely
welcome resources.
Comment Cards
Comment
Card
In
Plan?
Comment/ Question
A.!
l.
i j
I
Everything was very good information and how to help other to live better
and haPPY-
8, ___ _ j Communication Practices: Communications and more resources and work
shops like this is (sic) very outstanding.
x Intervention Strategies: [Offer] Programs after school and more
counseling.
+:a 'am-Jet 1-7_;1Other Comments: Very good.
B.x Policy & Governance: Mental Health, Domestic Violence, Alcohol and
Other Drugs, Violence in the workplace/ school all share common
prevention themes. Address issues of general community well-being that
would be the foundation of community well-being in the media campaign.
x Community Education: Need to include [thel entire community[,] so that
means engaging workplace/ employers, like HP, IBM, Bank of America et al.
Their issue is workplace violence/ suicide. What does Employee Assistance
Program (EAP) do?
x Communication Practices: If IBM says being a good parent is a corporate
value and supports that, parents [employed therel will listen.
C.x Policy & Governance: Leaders must be first educated about what needs to
be & how they can help.
x Community Education: Information should be reliable where people can get
it & in multiple places- all media forms, schools, etc.
x Communication Practices: Educate & advocate not using the word
"commit" in context of suicide (negative).
x Data Collection and Monitoring Activities: Mental autopsies of victims &
attempters. Psychological profiles
x Intervention: Access to means to self harm should be restricted as much as
possible. Teachers & schools should help is de-stigmatizing mental health.
Means Restriction
ro'a-"1
Ll.__;
Other comments: Thanks for your work on this.
D.x A big effort, but not new and effective plans. From now on, cigarette
smokes (sic) is pushed into death end. No more place for them to smoke.
Non-smokers take advantages and harassed cigarette addicts a lots (sic) Be
careful!!!! (sic) Paradigm Shift
x Community Education: To educate people is not effective is to give people
awards, even though it's just a letter from authority or a certificate.
Communication Practices: Authorities and specially psychiatrists & case
o
o
Packet Pg. 618
manager act according to work rules, but not help consumers with all their
hearts. Please educate them first.
x Data Collection and Monitoring Activities: [lsl Needed but don't go into
personal detailed information.
x Intervention: Prevention is more priority. Need hotline personnelle (sic) to
be able to help people in trouble some suggestion to get out of it
Don't ignored. (sic) And remember to follow up. It may recur.
x Other comments: I has (sic) some problems myself that can't be told.
Please think about some ways to detect or discovered (sic) a person's
suicidal thought. Public Awareness and Empowerment
E.Other comments (0-15, 16-24): We need emergency phones that connect
to suicide prevention at the [trainl tracks in Palo Alto. Kids would not want
to use their own cell phones for that because they do not want to leave any
trace.
Santa Clara County Suicide Prevention Public Forum
POST-IT NOTES
From Poster Boards
[U /. Policy and Governance Advocacy
1. New Strategies
Consider putting (real) phones on hot spots so people can call for help when feeling
suicidal.
x Additional idea: National Suicide Hotline. Consider idea to create a national number
such as 1-800-CHOOSE LIFE (or local city number that transfers to hotline #).
Preserve continuity of services: exclude County-contracted services from the General
Fund.
x Really focus on schools - even at the elementary school level.
x Consider an advocacy day (SACS) during May or other suicide awareness month
x Need to build bridges with law enforcement and other first responders.
x Bring a victim to share a story (if possible). It will help to change and enforce positive
change.
a) Edits to Strategies
x Raising awareness and educating everyone of all systems and partners of their key roles
and explaining what the key note is.
b) Additional Comments
x Countywide hotline is not new. In fact, it can't exist (sic- function well) when the
receivers or staff on the other side are not necessarily culturally and/or linguistically
competent!!! Itwouldbemorepracticalorpersonaltocontractoutwithcommunity-
based ethnic group or entity to do it. To be model friendly, use grassroots not just
contract agencies or county employee hotline, etc.
c) Wall Graphic
There are pros and cons of all policies
x Look at the root cause of individuals who die by suicide
x There are political benefits of increased awareness
x Suicide is a public health problem
x Partnership with primary health care professionals - this is critical
Government shouldn't be too heavy handed
x Hospitals must report suicide attempts
x Leverage funding and get the "best bang for our buck"
Immigration rules are tremendous on the individuals - need to integrate more
compassion
II. Community Education and Information
a) New Strategies
Right focus re: recreation centers after school. Not try to shut them down, no money
for the education.
Have a forum of "experts" of people who committed suicide. Tell what went wrong.
Ask therapists to attend, but the first speakers should be survivors.
x Have special programs that worked in the past. Ask community what will work.
x Have special programs that target youth families.
x Make prevention and intervention strategies more accessible to concerned friends and
relatives. (Aggressive campaign - poster boards, community presentation)
IP More volunteer program, keep them [youthl busy and out of gangs
f!Include community education workers that speak the many languages spoken in this
community.
x Training and police officers responding to 5150 calls.
W Have more training to target youth.
x Sounds good the plan will work out well. Encourage the loved one to talk about it.
b) Edits to Strategies
For grief counseling, lower the requirements to be helped. Educate people that crisis
' line is also for mental health support.
c) Additional Comments
x Your suggested strategies for community education and information are excellent.
People need to be desensitized to the subject to feel empowered.
SACS does outreach we used to do more than now. Volunteers for this are difficult to
keep the same 2 or 3 people were doing all the outreach talks.
x Make sure you publicize as much as possible. Get support from City Councils and get
the word out to the public.
d) Wall Graphic
x 24-hour telephone service, center
x Educate peers to take next step, training
o
o Parents
o Teens, pre-teens
o Teachers
o Firefighters
x Access points for resources, schools
x Tools for communication
o Fishbowl technique
o Social networking sites
x Heighten awareness
x Need to repair communication break down
x Normalize conversation around suicide
x Advertising for prevention
Ill. Communication Practices
a) New Strategies
Reassuring the victim that everything is confidential.
x Have forum with suicide attempters. Talk about their experiences.
x Better educate foster parents particularly. Social workers, teachers on how to spot
ones in trouble.
x Have talks and trainings in the schools. Involve the youth in trying to define messages.
Everyone who wants a job in the County Psychology Department needs to go through
SACS training first.
x Your strategies for communication practices are excellent. I would only add developing
strategic relationships with the media - otherwise it's "whatever bleeds, leads!"
x Use communication resources that connect with youth.
Respecting the privacy of the victims of suicide is key, especially for minors.
x It's good! I think to use authentic community leaders who are much familiar to the
residents and cultural groups of their own communities would be much more effective
judge than the county.
x Encourage the attempts to talk about his/her crisis.
x Every 1st responder: police, fire, EMT - gets SACS training.
x Use communication resources that connect with specific communities.
b) Additional Comments
Perhaps obituaries or death notices might say: "was so depressed he committed
suicide" (and did it by....)
c) Wall Graphic
x Change paradigm - DUI, smoking
x Gift of story
x Welcoming, vivacious spirit
x Media is a resource
Needs to be educated, how to communicate message
x Churches and temples - places other than schools
x Hotline number is too long - need a 3 digit number!
x Public health issue
x Develop common language
IV. Data Collection and Monitoring
a) New Strategies
List failures of the treating therapists and doctors. List anti-depression medication the
person was taking. List medications on which the person suicided.
Use things that work/didn't work. Then find solutions.
x Collectstatisticsonsuicideattempts. Especiallyteens.
x Ensure continuum of data collection and analysis cross systems.
x From the current data, you had online I noticed specific zip codes with high rates of
suicide this information is critical to developing targeted messages for each
community. '
x Encourage the attempter to talk about his/her crisis.
Start keeping data on how many suicides were taking Paxol and other SSU medications
for bi-polar
b) Additional Comments
x Psych[ological] autopsy.
c) Wall Graphic
x [Monitor?] Caltrain entrance sites
x Examine, study group deaths
V. Intervention Strategies
a) All Ages
Resist the effort to medicate[.] [Mental Health?] centers closely monitored
x Make it not-taboo to talk about
b) Wall Graphic
X i Community ownership
x Take time with the individual
x Cultural differences - severe stigma against mental health
Same cultures need to support each other
E.g. Vietnamese culture
x Honor, aware people for work with suicide prevention
x Stigma in discussing suicide even in mental health profession.
Children and Youth Ages 0 to 15
a) New Strategies
x Listen to them and need to respond to bullying
x Bullying at schools by peers on (sic- to) a teachers and administrators.
x Training with at-risk to hear their concerns and how they would like to be listened to.
x Developmental Asset Building for youth - Project Cornerstone
Teen support groups for survivors of teen suicide.
Youth involved in community service.
x Involve schools in planning prevention pre K through Grade 12
Additional idea - introduce the season(s) for non-violence (begun by Gandhi's
grandson in 1997 at the United Nations to schools. Give teens and teachers idea to
incorporate suicide prevention into the nonviolence curriculum. Utilize PSA"s radio and
television.
x Advertise, advertise, advertise. Foster parents especially.
x Racism leads to feelings of low self-esteem, depression, helplessness, etc. This
continues for all ages.
x Increase curriculum involving self-esteem and ethics or "telling" someone older about
a potential problem, encourage. Also teach "responsibility age-specific level"
x Important not to "single out" at risk kids. Better to make broad strokes.
Have teachers compliment students example: "Good question, Joe!"
Developmental Assets: Project Cornerstone.
x Use social networking potential.
b) Edits to Strategies
x You forgot prevention: should be a separate category.
x Include reaching out to students experiencing academic difficulties
Prevention strategies should be formulated:
Youth Developmental Assets; Caring school environment; Service Learning
c) Additional Comments
x Racism against Latinos is high!
$:
ffl
aa
Packet Pg 624
x I think the most important thing is a societal shift to isolating individuals less. This is a
cultural issue. E.g. computer culture.
x Listen to youth ! Be a friend not a stranger!
d) Wall Graphic
x Parents need to connect with kids, youth, teens
x Bullying in schools: outreach, parent support needed
x Dinner with your children
x Educate - healthy foods, exercise
x Empower kids, youth, teens
Youth and Young Adults Ages 16 to 24
a) New Strategies
x Moving, family relations, unsatisfying work - pressure once returned to house of origin
x Parent-child communication training workshops including teens and parents
x Internet
x Youth forums: to hear our youth - what do they day they need?
x Peer counselors opportunities to get trained in age-specific ways in crisis intervention
and discussing the "ethic" or "telling"
Community service for youth
x Training and police officers responding to 5150 calls
x Services list of therapists - hospital with adolescent units
Peer to peer college student training and education - early detectional screening in
college health services
x Making resources, help lines more obvious and culturally sensitive
x Strong need for prevention strategies. Should be called out!
x Include bullying ISSUES
x Educate parents about how to address mental health iSsues - that may emerge when
their students are away at college
To finish the high school and get the diploma or GED
Tell teachers to compliment students, e/g/ "Hey Joe, that was a good question!"
Like peer stipend program - may listen to them more than adult
x Treating suicide as a medical issue it could be argued is culturally biased
already...However, I think if you look at your whole program you do not focus on the
medical side only.
x If screen people, where are the therapists/hospital beds to put them if needed?
x Comprehensive health, curriculum including social, emotional health
School nurses should be involved!
x Education ! Training of educators, community leaders, parents, youth about signs and
calls for help!
x Individuals with physical disabilities-including but not limited to injuries that changes
an individuals life? Exp - head injury, parapalegic, quadrapalegic, stroke, etc.
x Immigration or refugee concerns acculturation stress linguistic cultural riff
x More information on suicide prevention is needed in Spanish
x Training targeting high school/community college (administrators, discipline, guidance
counselors, staff)
x More sensitive and compassionate media coverage needed
b) Edits to Strategies
We need prevention! Separate category
c) Additional Comments
x Listen to youth ! Make connections, be a friend.
d) Wall Graphic
Budget cuts in schools impact counseling. Need community-based counselors/peers
Adults Ages 25 to 59
12-step model
x No cost counseling or crisis services
x Intervention strategy for adults - tie your intervention with de-stimatizing desensitizing
to subject normalizing seeking help and providing hope
Class versus counseling - and counseling when needed
x Peer to peer college student training
x Provide training for family members
x Include adults experiencing job loss and time period out of work
x College faculty training (higher education)
x Work place problems - may be the ls' place where problems are noticed. Include
training supervisors, etc.
x Single, middle-age me
x Need to provide targeted resources to returning serve members who are at high risk
for suicide. Their families are also at high risk for violence, depression and suicide.
Wall Graphic
x Job loss
Provide unemployed with resources, information
Mandate provision of information
Parent's impact on entire family
x Foster parents
x Parents need resources, tools to help prevent suicide
Older Adults Ages 60+
x Add priority populations. Health or family health of suicide identification or attempts.
Packet Pg 626
Additional idea - fundraisers such as a wing into life golf tournament for schools,
community organizations, Or contract agencies.
x Make homebound services/disabled a priority!! For outreach and address isolation
issue.
x Ilike the idea of a mobile unit(s). I think advertising in all forms of media (TV, radio,
newspapers, magazines, etc.) is necessary.
a) Additional Comments
The "forgotten" population. I've heard it said that they are underserved by the new
PEI Plan.
b) Wall Graphic
x Community ownership of plan is important!
x Connect with people
x Reality affects society, people
x Stigma of seeking help, change this!
x Separate prevention and intervention
Medicine side effects impact suicide risk
o
Attachment 5. Palo Alto Unified School District Suicide Prevention and Mental
Health Promotion Policy
Students BP 5141.52
SUICIDE PREVENTION AND RELATED MENT AL HEALTH PROMOTION
The Board of Education recognizes that suicide is a major cause of death among youth and should be taken
seriously. In order to attempt to reduce suicidal behavior and its impact on shidents and families, tlie Superintendent
or designee shall develop preventive strategies and intervention procedures.
The Superintendent or designee shall involve school health professionals, school counselors, administrators, other
staff, parents/guardians, students, local health agencies and professionals, and comrmmity organizations in planning,
implementing, and evaluating the district's strategies for suicide prevention and intervention.
Prevention and Instruction
Suicide prevention strategies shall include, but not be limited to, effoits to promote a positive school climate that
enhances students' feelings of connectedness with the school and is characterized by caring staff and harmonious
interrelationships among students.
The district's instriictional and student support program shall promote the healthy mental, emotional, and social
development of students inchiding, but not limited to, the development of problem-solving skills, coping skills, and
resilience.
The Superintendent or designee may offer parents/guardians education or information which describes the severity
of the youth suicide problem, the district's suicide prevention efforts, risk factors and warning signs of suicide, basic
steps for helping suicidal youth, reducing the stigma of mental illness, and/or school and community resources that
can help youth in crisis.
Staff Development
Suicide prevention training for staff shall be designed to help staff identify and find help for shidents at risk of
suicide. The training shall be offered under the direction of district staff and/or in cooperation with one or more
community mental health agencies and may include information on:
1. Research identifying risk factors, such as previous suicide attempt(s), history of depression or mental
illness, substance use problems, family history of sriicide or violence, feelings of isolation, interpersonal
conflicts, a recent severe stressor or loss, family instability, and other factors.
2. Warning signs that may indicate suicidal intentions, including changes in shidents' appearance, personality,
or behavior.
3. Research-based instnictional strategies for teaching the suicide prevention curriculum and promoting
mental and emotional health.
4. School and community resources and services for shidents and families in crisis and ways to access them.
5. District procedures for intervening when a shident attempts, threatens, or discloses the desire to die by
suicide.
BP 5141.52
Packet Pg. 628
[I
SUICIDE PREVENTION AND RELATED MENTAL HEALTH PROMOTION (continued)
Intervention
Whenever a staff member suspects or has knowledge of a student's suicidal intentions, he/she shall promptly notify
the principal, another school administrator, psychologist, or school counselor. The principal, another school
administrator, psycliologist, or corinselor shall tlien notify the shident's parents/guardians as soon as possible and
may refer the student to mental health resorirces in the school or community.
Shidents shall be encouraged through the education program and in school activities to notify a teacher, principal,
another school administrator, counselor, or other adult when they are experiencing thouglits of suicide or when they
suspect or have knowledge of another student's suicidal intentions.
The Superintendent or designee shall establish crisis intervention procedures to ensure student safety and
appropriate communications in the event that a suicide occurs or an attempt is made by a member of the shident
body or staff on campus or at a school-sponsored activity:
Also see:
cf. 4131-StaffDevelopment
cf. 5022 - Student and Family Privacy Rights
cf. 5125-StudentRecords
4 5030 - Student Wellness
4 5141 -Health Care andEmergencies
cf. 5137-PositiveSchoolClimate
cf. 5143 - Nondiscrimination/Harassment
cf. 6142.8 - Comprehensive Health Education
cf.6164.2 - Guidance/Counseling Services
Policy
adopted: June 1, 2010
PALO ALTO UNIFIED SCHOOL DISTRICT
Palo Alto, California
Students AR 5141.52
SUICIDE PREVENTION AND RELATED MENT AL HEALTH PROMOTION
Prevention and Instruction
Tlie District's suicide prevention curricukim sliall be designed to help students to:
1. Identify and analyze signs of depression and self-destnictive behaviors and understand liow feelings of
depression, loss, isolation, inadequacy, and anxiety can lead to thoughts of suicide.
2. Identify alternatives to stiicide and develop coping and resiliency skills.
3. Learn to share feelings and get help when friends are showing signs of suicidal intent.
4. Identify community crisis intervention resources where help is available and recognize that there is no
stigma associated with seeking mental health, substance abuse, gender identity, or other support services.
Staff Development
1. Annual in-service suicide prevention training will be conducted in order for the district staff to learn to
recognize the warning signs of suicidal crisis, to understand how to lielp suicidal youths, and to identify
community resources. All staff will learn to identify potentially suicidal students, to take preventative
precautions, and to report suicide threats to the appropriate authorities. Training will be offered under the
direction of trained district counselors/psychologists.
2. Staff shall promptly report suicidal threats or statements to the principal or to a trained district
counselor/psychologist, who shall promptly report threats or statements to the student's parents/guardians
and take appropriate action until the parent or guardian arrives.
Intervention
Immediate Intervention for a Suicide Threat or Attempt
When a suicide attempt or threat is reported, the principal or designee shall:
1. Ensure the student's physical safety by one of the following, as appropriate:
a. Securing immediate medical treatment if a suicide attempt has occurred.
b. Securing law enforcement and/or other emergency assistance if a suicidal act is being actively
threatened.
c. Keeping the shident under continuous adult supervision until the parent/guardian and/or
appropriate support agent or agency can be contacted and has the opportunity to intervene.
THE STUDENT MUST NOT BE LEFT ALONE.
AR 5141.52
SUICIDE PRF,VE,NTION AND RELATED MENTAL HEALTH PROMOTION (continued)
2. Designate specific individuals to be promptly contacted, including the school counselor, psychologist,
mirse, superintendent, and/or the student's parent/guardian, and as necessaiy, local law enforcement or
mental healtli agencies.
3. Document the incident in writing as soon as feasible.
4. Follow up witli tlie parent/guardian and student in a timely manner to provide referrals to appropriate
services as needed.
5. Provide access to counselors or other appropriate personnel to listen to and support shidents and staff who
are directly or indirectly involved with the incident at the school.
6. Provide an opportunity for all who respond to the incident to debrief, evaluate the effectiveness of the
strategies used, and make recommendations for future actions.
7. Document the steps taken in the student's record.
8. Develop an effective plan for reintegration of the student into school following the crisis.
Intervention after a Death Suggested to be Suicide
When a tragedy occurs and a shident dies, the principal or designee shall:
1. Contact the Superintendent. District Office staff will contact other schools and remind them to identify and
provide counseling to any student who might have known or been connected in any way with the shident
who died.
2. Call an emergency staff meeting to relay known infomiation and formulate appropriate procedures for
supporting shidents, staff, and parents. The death should not be called a suicide. This is a legal
determination that can only be made by the coroner's office. It should be refeired to as a death or a tragic
death.
3. Talk with students who were in class with the student by going to that classroom.
4. Contact other students who might know the stiident in direct, one-to-one conversations.
5. Provide counseling support to students. Contact additional psychologists/counselors to increase the
available support. Have a place available for students to go to (Support Room) and walk around campus to
be available for any student needing support. Counselors should follow the student's schedule and be
available to assist the students and teachers in those classes. Students rmist be allowed to grieve, but there
should be no large group gatherings such as an assembly. Students should not be allowed to congregate in
groups without adult supervision. Identify any students who might be at risk and call them in to talk.
6. Contact the family to express condolences and to let them know what the school is doing. Ask when the
family would like the student's personal items returned to them. The shident's locker should be cleaned
out and contents rehirned to the parents at an appropriate time.
o
AR 5141.52
SUICIDE PREVENTION AND RELATED MENTAL HEALTH PROMOTION (continued)
7. Designate a spokesperson who will respond to qriestions aiid inquiries from the media and work with the
media to assure responsible reporting (see American Formdation for Suicide Prevention guidelines).
8. School will be conducted as usual to tlie greatest extent possible. In no case sliould school be canceled.
9. Prepare a note to send home to parents indicating that a tragic death has occuired and that post intervention
procedures and counseling has begun.
10. Schedule a parent meeting as soon as possible to help parents deal with the issue and to advise them how to
help students.
Also see:
44131-StaffDevelopment
cf. 5022 - Student and Family Privacy Rights
cf.5125 - Student Records
cl 5030 - Student Wellness
cf. 5141 - Health Care and Emergencies
cf. 5137-PositiveSchool Climate
cf.5143 -Nondiscrimination/Harassment
4 6142.8 - Comprehensive Health Education
4 61 64.2 - Guidance/Counseling Services
Approved: June 1, 2010
PALO ALTO UNIFIED SCHOOL DISTRICT
Palo Alto, California
Packet Pg. 632
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Attachment 6. References
I Behavioral Risk Factor Survey, Santa Clara County 2004 Chartbook, Santa Clara County Public
Health Department, 2004
2 California Department of Health: Epic Data
3 http://www.sprc.org/grantees/statetribe/2010/7B%20lnspire%20USA%20handout.pdf
4 Ibid
5 Center for Health Statistics-Vital Statistics Query System.
http://www.applications.dhs.ca.gov/vsq/screen4a.asp?cntycd=43&YEARDATA=2007&Criteria
=1&Resocc=Residence&BirthDeath=Death&stats=2&codcd=424 Retrieved 3/4/10.
6California Department of Public Health, County Health Status Profiles 2009, retrieved 3/9/10
' Number is based on the above-established rate.
8 Center for Health Statistics-Vital Statistics Query System.
http://www.applications.dhs.ca.gov/vsq/screen4a.asp?cntycd=43&YEARDATA=2007&Criteria
=l&Res occ=Residence&BirthDeath=Death&stats=2&cod cd=424 Retrieved 3/4/10.
9 Ibid
lo California Department of Public Health, Center for Health Statistics, Vital Statistics Query
System. http://www.applications.dhs.ca.gov/vsq/default.asp.
Retrieved 3/3/10 through kidsdata.org
Il The Trust about Suicide: Real Stories of Depression in College.
http://www.afsp.org/files/CollegeFilm//factsheets.pdf Retrieved 3/4/10
12 Mental Health America Suicide Fact Sheet. http://www.mentalhealthamerica.net/go/suicide
Retrieved 3/4/10
13 Ray Hodgson, Tina Abbasi, Johanna Clarkson. 1996. Effective mental health promotion.
Health Education Journal, 55, 55-74
14 National Strategy for Suicide Prevention, US Dept. of Health and Human Services, 2001, p 41
15 Sanford C and Hedegaard H (editors). Deaths from Violence: A Look at 17 States-Data from
the National Violent Death Reporting System. December 2008.
16 Youth Suicide Fact Sheet. www.suicidology.org. Retrieved 4/22/10.
' CDC. Suicide among children, adolescents and young adults-United States, 1980-1992.
MMWR Morbidity Mortality Weekly Report 1995; 44(15):289-91
'8 California EpiCenter database
19 Behavioral Risk Factor Survey, Santa Clara County 2004 Chartbook, Santa Clara County Public
Health Department, 2004
2o Santa Clara County Youth Suicide Rate 2005-2007. California Department of Public Health,
Center for Health Statistics, Vital Statistics Query System.
http://www.applications.dhs.ca.gov/vsq/default.asp. Retrieved 3/3/10 through kidsdata.org
21 Youth Suicide Fact Sheet. www.suicidology.org. Retrieved 4/22/10.
22 California EpiCenter database
23 American Foundation for Suicide Prevention,
http://www.afsp.org/index.cfm?fuseaction=home.viewPage&pageid=E2464DF6-0397-BD56-
A8E232923BO4ED5C Retrieved 3/4/10
Packet Pg. 634
24 Potter, L., Silverman, M., Connorton, E., & Posner, M. (2001). Promoting mental health and
preventing suicide in college and university settings. Suicide Prevention Resource Center.
Retrieved October 15, 2007, from www.sprc.org/library/collegespwhitepaper.pdf.
25 Benton, S. A., Robertson, J. M., Wen-Chih Tseng, Newton, F. B., & Benton, S.L. (2003).
Changes in counseling center client problems across 13 years. Professional Psychology:
Research and P'ractice, 34(1), 66-72.
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4/14/10
2' Santa Clara County Suicide Prevention Advisory Committee Basic National Data, presented by
Victor Ojakian on January 13, 2010. http://www.sccmhd.org/SCC/docs/Mental Health Services
(DEP)/attachments/NationalStateDataonSuicideslidesMtg1132010.pdf. Retrieved
4/23/10.
28 American Association of Suicidology: Suicide and the Economy. Available at
http://www.suicidology.org/web/guest/current-research. Accessed May 19, 2010.
29 California EpiCenter database
" Ibid
31 The National Alliance on Mental Illness. Communities: Major Depression. Available at:
http://www.nami.org//Template.cfm?Section=majordepression&
template=/Forums/TopicDisplay.cfm&ForumlD=1&ForumActiveFlag=Y&TopicActiveFlag=Y.
Accessed August 13, 2007.
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4/14/10 aa
33 Kulkin, H., E. Chauvin, & et al. (2000). Suicide among gay and lesbian adolescents and young
adults: a review of the literature. Journal of Homosexuality, 40(1), 1-29.
34 Remafedi, G., J. A. Farrow, et al. (1991). Risk factors for attempted suicide in gay and bisexual
youth. Pediatrics, 87(6), 869-875.
35 Eisenberg, M. E., & Resnick, M.D. (2006). Suicidality among gay, lesbian and bisexual youth:
The role of protective factors. Journal of Adolescent Health, 39(5), 662-668.
36 Kessler, R., Borges, G., & Walters, E. (1999) Prevalence of and risk factors for lifetime suicide
attempts in the national comorbidity survey. Archives of General Psychiatry, 56, 617-626
37 The Archives of Pediatric and Adolescent Medicine (May 1999)
38 Ibid
39DataSummarySheetonSuicideDeathsandNon-FatalSelf-lnflictedlnjuries. California
Department of Mental Health, Office of Suicide Prevention. (2007).
4o American Foundation for Suicide Prevention.
http://www.afsp.org/index.cfm?fuseaction=home.viewpage&pageid=04ECB949-C3D9-5FFA-
DA9C65C381BAAEC0, retrieved 6/26/10
41 Court addresses causes of juvenile delinquency, San lose Mercury News, November 23, 2002
42 Huskey & Associates in association with National Council on Crime and Delinquency, Profile of
In-Custody Minors in Santa Clara Countyt, CA, Santa Clara County Probation Department,
Preliminary Findings, July 17, 2008
43 Huskey & Associates in association with National Council on Crime and Delinquency, Profile of
Out of Custody Minors, Santa Clara County Probation Department, Preliminary Findings,
September 2, 2008
44 Data provided by the Santa Clara County Department of Probation, 4/15/10
45 0ffice of Justice Programs, Bureau of Justice Statistics. Suicide and Homicide in State Prisons
and LocalJails, Christopher J. Mumola, August 21, 2005, NCJ 210036.
http://bjs.ojp.usdoj.gov/index.cfm?ty=pbdetail&iid=ll26
46 Ibid
47 Data provided by the Santa Clara County Department of Correction, 4/5/10
48 Ibid
49 New Navy Program Encourages Sailors to "ACT" to Prevent Suicide. Navy.mil (Official
Website of the u.s. Navy) Story Number: NNSO61203-09. Release Date: 12/4/2006 9:01:00 AM.
Retrieved 4/22/10
5o Charles W. Hoge, M.D., et. al, Combat Duty in Iraq and Afghanistan, Mental Health Problems,
and Barriers to Care, The New England Journal of Medicine, July 1, 2004, Vol. 351, No I
51 Kaplan, M.S., Huguet, N., McFarland, B.H., & Newsom, J.T. (2007), Suicide among male
veterans: a prospective population-based study, Journal of Epidemiology and Community
Health, 61(7), 619-24.
52 Eli Clifton, U.S.: Suicide Rate Surged Among Veterans, Washington, Jan 13, 2010
53 Ibid
54 Mark S. Kaplan, DrPH, Bentson H. McFarland, MD, Phi, and Nathalie Huguet, PhD, Firearm
Suicide Among Veterans in the General Population: Findings From the National Violent Death
Reporting System, The Journal of TRAUMA"' Injury, Infection, and Critical Car, Volume 67,
Number 3, September 2009
55 American Fact Finder. TM-PO44. Percent of Civilian Persons 18 Years and Over Who Are
Veterans: 2000, Universe: Civilian population 18 years and over, Data Set: Census 2000, SF 3
56 Parent, Richard 2004. "Aspects of Police Use of Deadly Force In North America - The
Phenomenon of Victim-Precipitated Homicide," ph.o. thesis, Simon Fraser University
' USAToday. Suicide rate jolt police culture. 2/8/2007
58 Selzer, M. L., & Payne, C. E. (1992). Automobile accidents, suicide, and unconscious
motivation. American Journal of Psychiatry, 119, p 239
59 Dennis L. Peck, Kenneth Warner (Summer, 1995). Accident or suicide? "Single-vehicle car
accidents and the intent hypothesis."
6o Murray, D.; de Leo, D. (Sep 2007). "Suicidal behavior by motor vehicle collision." Traffic Injury
Prevention 8 (3): 244-7. : 10.1080/15389580701329351. PMID 17710713
61 http://www.menstuff.org/issues/byissue/unintentional-suicide.html. Retrieved 4/21/10.
62 Scott Poland, District Administration, Solutions for School District Management, "Preventing
Cluster Suicides," October 2009
63 Brent DA, Moritz G, Bridge J, Perper J, Canobbio R (May 1996). "Long-term impact of
exposure to suicide: a three-year controlled follow-up". Journal of the American Academy of
Packet Pg. 636
Child and Adolescent Psychiatry 35 (5): 646-53. doi: 10.1097/00004583-199605000-00020.
PMID 8935212
64 Phillips DP, Carstensen LL (September 1986). "Clustering of teenage suicides after television
news stories about suicide." New EnglandJournal of Medicine. 315 (11): 685-9. PMID 3748072.
65PictureThis:DepressionandSuicidePrevention. PreparedfortheSubstanceAbuseand
Mental Health Services Administration (SAMHSA) by the Entertainment Industries Council, Inc.
http://www.eiconline.org/resources/publications/zpicturethis/Disorder.pdf. Retrieved
4/14/10
66 American Association of Suicidology, Scott Poland, Prevention Director, "Preventing Cluster
Suicides," District Administration Solutions for School District Management, October 2009
67 American Roulette: Murder-Suicide in the United States. Violence Policy Center.
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Mental Hea(th Services Administration (SAMHSA) by the Entertainment Industries Council, Inc.
(EIC),under subcontract to ENCORE Management Corporation, contract number 280-02-0701,
with SAMHSA, u.s. Department of Health and Human Services (HHS).Anne Mathews-Younes,
Ed.D., Government Project Officer.
http://www.eiconline.org/resources/publications/zpicturethis/Disorder.pdf. Retrieved
4/14/10
69 Robins, E. (1981).The final months: A study of the lives of 134 persons. NY: Oxford University
Press.
7o Barraclough, B., & Hughes, J. (1987). Suicide: Clinical and epidemiological studies. London:
Croom Helm.
71 Conwell,Y., Duberstein, P.R., Cox, c., Herrmann, J.H., Forbes, N.T., and Caine, E.D. (1996).
Relationships of age and axis I diagnoses in victims of completed suicide: a psychological
autopsy study. American Journal of Psychiatry, 153, 1001-1008.
72 Brent, 0.4., Perper, J.A., Moritz, G., Allman, c., Friend, A., Roth, c., & et al. (1993). Psychiatric
risk factors for adolescent suicide: a case-control study. Journal of the American Academy of
Child and Adolescent Psychiatry, 32 (3), 521-529.
73 Shaffer, D., Gould, M.S., Fisher, P.,Trautman, ph., Moreau, D., KJeinman, M., & et al. (1996).
Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53 (4),
339-348.
74 Potter, L., Silverman, M., Connorton, E., & Posner, M. (2001). Promoting mental health and
preventing suicide in college and university settings. Suicide Prevention Resource Center.
Retrieved October 15, 2007, from www.sprc.org/library/collegespwhitepaper.pdf.
75 Kidsdata.org, a program of the Lucile Packard Foundation for Children's Health
75 Kids in Common 2007 Santa Clara County Children's Report
'7 Santa Clara County Department of Public Health and WestEd. California Healthy Kids Survey
2005-2006.
78PictureThis:DepressionmdSuicidePrevention. PreparedfortheSubstanceAbuseand
Mental Health Services Administration (SAMHSA) by the Entertainment Industries Council, Inc.
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4/14/10
79 American Foundation for Suicide Prevention,
http://www.afsp.org/index.cfm?fuseaction=home.viewPage&pageid=E2464DF6-0397-BD56-
A8E232923BO4ED5C. Retrieved 3/4/10
8oPictureThis:DepressionandSuicidePrevention. PreparedfortheSubstanceAbuseand
Mental Health Services Administration (SAMHSA) by the Entertainment Industries Council, Inc.
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4/14/10
81 Regier, D.A., Farmer, M.E., Rae, D.S., et al. (1993). One-month prevalence of mental
disorders in the United States and sociodemographic characteristics: The epidemiologic
catchment area study. Acta Psychiatria Scandinavica, 88, 35-47.
82 Conwell Y, Brent D. Suicide and aging. I: patterns of psychiatric diagnosis. International
Psychogeriatrics, 1995; 7(2): 149-64.
83 Conwell Y. Suicide in later life: a review and recommendations for prevention. Suicide and
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84 Health Trust, Health Aging Initiative. http://www.healthtrust.org/initiatives/aging/facts.php.
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85 Santa Clara County Public Health Department, Epidemiology and Data Management, 2005-
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86 Substance Abuse and Mental Health Services Administration, Office of Applied Studies.
(October 11, 2007). The NSDUH Report: Depression among Adults Employed Full-Time, by
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87 "Veterans Stress Cases Up Sharply," USA Today, act. 18, 2007,
http://www.usatoday.com/news/washington/2007-10-18-veterans-stressN.htm
88 Ibid
89 Defense Medical Surveillance System, Post Deployment Health Self-Assessment of Service
Members Who Had Served in Iraq, Behavioral Health Services for Veterans and their Families,
February, 2008, p.l.
9o Leonard, Power Point Presentation, "Welcome to the Veteran Services Town Hall Meeting."
91 All about Depression, Suicide and Depression.
http://www.allaboutdepression.com/gen04.html Retrieved 3/4/10
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Mental Health Services Administration (SAMHSA) by the Entertainment Industries Council, Inc.
(EIC),under subcontract to ENCORE Management Corporation, contract number 280-02-0701,
with SAMHSA, u.s. Department of Health and Human Services (HHS).Anne Mathews-Younes,
Ed.D., Government Project Officer.
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4/14/10
93 The Trust about Suicide: Real Stories of Depression in College.
http://www.afsp.org/files/CollegeFilm//factsheets.pdf Retrieved 3/4/10
94 Santa Clara County Public Health Department, Behavioral Risk Factor Survey, 2005-2006
95 0xford Journal of Medicine: An International Journal of Medicine, Volume 99, Number 1, Pp.
57-61
96 Hufford M. R., Alcohol and suicidal behavior. Clinical Psychology Revievv 2001; 21:797-811.
97 Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D. Factors Contributing To Suicide Risk,
Updated: act 24th 2007
98 Protective Factor List Published by the u.s. Public Health Service 1999
99 Centers for Disease Control and Prevention, Suicide Prevention Scientific Information:
Prevention Strategies." http://www.cdc.gov/ncipc/dvp/Suicide/Suicide-prvt-strat.htm.
Accessed 5/12/10.
loo Santa Clara County Mental Health Department 2009 data
lol http://www.sprc.org/grantees/statetribe/2010/7B%20lnspire%20USA%20handout.pdf
lo2 Clebsch, W. A., Jaeckle, C. R. 1983
lo3 Community for a Lifetime, 2005
lo4 Developed in a collaborative effort among American Foundation for Suicide Prevention
(AFSP), the Annenberg Public Policy Center, the National Institute of Mental Health, the Office
of the Surgeon General, the Centers for Disease Control and Prevention, the Substance Abuse
and Mental Health Services Administration, the American Association of Suicidology, the World
Health Organization and several other agencies.
lo5 Santa Clara County Mental Health Department 2009 data